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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIARTMENT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> - FACGrY E <br /> FACILITY CONTACT NAME . . <br /> FACILITY Hy� <br /> SITE PNOI'IE#MVfhl AREA CODE <br /> CITY. <br /> UP <br /> ST <br /> _. IIP CODE #(>F TANKS AT SITE <br /> CA <br /> APPLICMIT BILLING NAME <br /> APPLXC <br /> ELITE IV CONTRACTORS CARRIE MILLER.CONTACTNnME <br /> INC <br /> APPLICANT MAILING ADDRESS. _ - - _ <br /> 2535 _WIGWAM DRIVE APPucaxr PHDNe#WTIN AREA CODE <br /> CITY STATE - ( 20!)) 461-6337 <br /> STOCRTON <br /> _ LF LODE CIRCLE WORK TO BE DONE <br /> - <br /> 95205 <br /> 95205 <br /> . - - - -Ct=we Us4Tation Repay Retrofit <br /> -ACTIVE FACILITY - <br /> 2003- <br /> $$DD FEE INCLLIDES FACILITY 1998 1999- <br /> FEE�ITANK�- Rvulx 2000 2001 . 200 <br /> MC 2 <br /> . { <br /> S125 PER TAAFTER FIRST TAMC ( � pf101xt°�"'�')- ... - -_ - _ . . <br /> TAMC PENALTYASSFSSE-D <br /> TANK SURCHARGE=$101 TAMC <br /> - STATE LU-RC"ARGE FOR FACILITIES NOT At READY ON INV$jTORY.INACUPA PROGRAM=S17.5G/FACflttt $ . <br /> - ....--....•. -�-PE3tY1ANENT CLOSURE .- ._ - - - _ <br /> ocPenncedCbsure)n Place - - - - - <br /> .. - TANK ID#(s):. - CLOSUtEFEE=-$279YI- #TANKSXS279= $ - <br /> TEMPORARY CLOSURE <br /> (Plan Review and tr�rwr3ons) - - - <br /> T - <br /> TANK ID#(s): - TETPORARRY CLOSURE FEE $ <br /> . . —$279/FACtCffY . <br /> . QiSTALlATION PLANCHECK - <br /> (Plan Cheri;and Cmmhxfim Lmpecf=). <br /> 7A[+iC N#(s): PLAN CHECK FEE=,$744/FACILITY $ - <br /> REPAIR PLAN C1fC1C - - - - <br /> TAMC IDA s): - . <br /> - TANKRETROFTTREPAIR FEE =$2791 FA.Ca1TY (use for ma,*Fmg equipment spolbudcets.laNc sumps.mac) $ q <br /> PIPINGREPAIRFEE =$279/FACILITY - (use forpip"ug:urder�speiisamntatrm tect) $ <br /> UISCE <br /> TRANSFER FEE _$20 $ - <br /> -CONSULTAT)ON FEE : = S 93I HOIS2 - $ - <br /> i <br /> IRJAUTHCYi1ZED RELEASE EVALUATIQN FEE . = S 93I HOUR .. $ <br /> $ <br /> SANO'1JNG B�LSPECTION FEE = S 93/HOUR - .�� .� � _ 1 <br /> . ' ALL FEES ARE BASED ON THE$93 HOURLY RATE T6fETHAT EXCCl3DS FEES PAIDYitt 6E BSLED"TO_ APPLiCAKT- - - <br /> OFFICE USE ONLY <br /> i <br /> . - SERVILE REQUEST i FACILM ID AIIIOUNTRECMED.:'. ..- CHECK C RECEIVED St DATE RFS.HVED - - i <br /> SR <br /> I <br />