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SAN . UIN COUNTY ENVIRONMENTAL HEALTH D TMENT <br />UNDERGR uND STORAGE TANK PROGRAM FPWORKSHEET <br />, <br />FACILITY CONTACT NAME <br />2001 <br />.. <br />15U, <br />?FAADtDN&SS <br />C1 f1 <br />SITE PHONE # WITH AR A CODETCA <br />$ <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />- ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIMF THAT FYrrrn<rrre eA..... <br />TATE <br />ZIP CODE # OF TANKS AT SITE <br />`Is <br />O b <br />ELITE IV CONTRACTORS, INC. �32tQr� k- �_3c)ob <br />APPLICANT MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br />2535 WIGWAM DRIVE <br />(209) 461-6337 <br />STOCKTON I CA I 95205 1 <br />Closure Installation Repair Retrofit <br />ACTIVE FACILITY <br />1998 <br />:$500 FEE INr...L:I IDES r'ACILTIY FEE +2 T.'1,^ii4 i>im7x:gents)'�avn)xlwak/ <br />$125 PER TANK AFTER FIRST TANK <br />1.999 2000 <br />2001 <br />.. <br />2007 <br />.- � <br />200f__. <br />$ <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />- ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIMF THAT FYrrrn<rrre eA..... <br />$ <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $10 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$17.50/ FACILITY <br />$ <br />PERMANENT CLOSURE <br />Removal Or Permitted Oosure in Place - . . <br />TANK ID # (s).CLOSURE FEE _ $279 /TANK # TANKS X $279 = <br />TEMPORARY CLOSURE - <br />(Plan Review and Inspections) <br />TANK ID#(s):- <br />TEMPORARY CLOSURE FEE = $279 / FACILITY <br />'MISCELLANEOUS - - <br />TRANSFER FEE —=-S 20 �$ <br />CONSULTATION FEE _ $ 93/ HOUR - <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE = $ 93 / HOUR - - - <br />$ <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />- ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIMF THAT FYrrrn<rrre eA..... <br />$ <br />9LL BE BILLED TO APPLICANT. <br />OFFICE USE ONLY <br />SERVICE REQUEST #- FAC) I AMOUNT HEI -F En I CHECXs RECEIVED BY DATE RECENFD <br />SR <br />EH 23 032 (REVISED 8/01103) <br />