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Jan 13 15 02:39P Elite Iv Contractors Inc 2094616342 P.5 <br /> v -.r <br /> REGE it = <br /> -- --- - � _ - - - - - - - - - -JAN' } 3-2015 <br /> SAN JGAQU3N COUNTYgNVIRONMENTAi <br /> .ENVIRONMENTAL HEALTH DEPARTNCENT '^^"f••"-+'mss" <br /> 1868 E.11,14toD Avc.,Stockton,CA 95205-6232 <br /> Telephoee:(209)468-3420 Foe:(209)468.3433 Web:W WW 0bd"M <br /> i <br /> . F NAME 'FACILITY ONTACT NAME <br /> SIT P ONE#• AREACO <br /> STA <br /> *OFTANKS TSITE <br /> CA q 2. <br /> APPLICANT CONTACT NAME <br /> =u��1-��•IIBcJ .. <br /> AN AILING ADDRE APPLICANT <br /> UHNN #WITH AR COD <br /> UJBSR. <br /> CITY SYA 23P CIRCLE WORK OBE DONE CONTRACTOR Ice# <br /> CbetXo InsWllatlon Re=V R---'- <br /> -ACTFA FACILITY <br /> 2008 2008 2010 2011 2012 <br /> 2007 <br /> 5500 FEE INCLUDES FACILITY FEE-I TANK(2007.2005) <br /> 5550 FEE INCLUDES FACILITY FEE+.1 YANK(2009-7012) : <br /> $125 PER TAMC AFTER FIRST TANK <br /> $ <br /> .TANCPE ASSESSED _ $ <br /> .._.. __ TANK SUR GE=$1r1TAN .. . . . 5 <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENT"ORV IN A CUPA PROGRAM= 40.00/FACRITV <br /> POMANERTCLOSURE <br /> vol a Pennilted Gosure m Plate 5 <br /> Y N I # s : CLOSURE FEE- 3751 TANK #TANKSX 75= <br /> TEMPORARY CLOSURE <br /> n Review ON Ins atbOS 5 <br /> TANK ID#e : TEMPORARY CLOSURE FEE=$3751 FACILITY <br /> INSTALLATION PLOW CHECK <br /> Plan Check mg crostn—n Ins 5 <br /> TANK[ON W: PLAN CNECKTEE= 10001 FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s) <br /> TANK RETROFIT REPAIR FIZE $3751 FACILITY(use formcMtodn9 agWPment epM sums,eVR uppradcs. <br /> ..._ ....__._ ........_.. ..._....... s tucks sum (WW. <br /> PIPING REPAIR E = 7S 1 FA ILITY 190 far I undard eaf M act <br /> 'MISCELLANEOUS <br /> 5 <br /> TRANSFER FEE = 26 <br /> 5 <br /> ' 'CONSULTATION FEE •E 1251 HOUR <br /> 'UNAUTHORIZED REL ASE EVALUATION FFE = 1261 HOUR 5 <br /> SAMPLINO INSPECTION FEE <br /> = 1251 HO R 5 <br /> ALL FEES ARE WA u ON THSFi2s LY RATE.TIM!THAT EXCEED Mks PAW Y.1LL BB BILUSD TD APPLICANT. <br /> TOTAL AMOUNT DUE 5 <br /> OFFICE USE ONLY .. .. <br /> - SERVICE REQUEST 1 FACLDY Aft RECEIVED' CHECKa R C BBY DATliR ! <br /> 23 021REVISED a W'2 w <br />