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S�3OAQUIN COUNTY ENVIRONLIENTAL HEALTH DE).-ARTMENT <br /> UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> PFA NAME CONTAC,kT NAME _ .. <br /> oo <br /> SITE S WITH AREA CODE .. <br /> lbb <br /> Com" STATE ZIP CODE 0 OF TANKS AT SUE . <br /> CA <br /> APPLICANT SELLING NAME APPLICANT CONTACT HAMS <br /> ELITE IVCONTRACTORS, INC_ CARRIE MILLER. <br /> APPLICANT MAILING ADDRESS. APPLICANT PHONE OWITH AREA CODE <br /> 2535 _wiGwAM DRIVE ( 209) .461-6337 <br /> CITY STATE ZIPfADECIRCLE WORK TO BE DONE <br /> 'STOCTCTvN CA` 95205 - Closure kmta 6m Repan Retrofit <br /> ACTIVE FACILITY - 1998 - 1999. 2000 <br /> . 2D01 2002 2003_ <br /> - <br /> $ D FEE INCLUDES FACILITY FEE+1 TANK- -(ittgx(awuv� p:ttolx«, ). . . . "_ ". . . <br /> :� - <br /> { S125.PERTANK ARM FRLSTTANK <br /> $ I <br /> TANK PEXALTYASSESSE() <br /> S. I <br /> TANK SURCHARGE=$101 TAW <br /> .. - STATE SLkRCHARGE FOR FACBIIIES NOT ALREADY ON IRV9(rORY INA COPA PROGRAM=$17.5Gf FACUTY ! <br /> i <br /> mPermileQ Ovskre m Place - .:.. --. _ <br /> TANK IDII(s)_.. - CLOSIREFEE=SZ79 YTAt.BC S7AMcs XS279= <br /> TEMPORARY CLOSURE - <br /> (PLa Review and knpecfic-) - - <br /> TANK 10.0(s). - TEMPORARY CLOSURE FEE=$2791 FAC&M . <br /> . TNSTAtlATxxt-Pt.ANCHEC(C . . <br /> (Plan CTed and Cortstruc5m tnsteUions) <br /> TAKIC ID±t(s): - P(11NC ECKFEE=$7441FACIL[TY <br /> REPAIR PLAN CHECK - - - <br /> TANK IDS <br /> TANKRETRORT REPAR FEE =$279/FACILITY (use for fnwAxing equipment spMbudcets.tank sumps-mise) �f . <br /> Plp(NG'REPAIRFg =5279/FACFI3'fY $ <br /> . (use forpipcgwder spenserc.Offunent ect) . <br /> WSCELLANEOU5 <br /> aTRANSFER FEE = $20 <br /> - -CONSULTATION FEE: =S 93/HOUR <br /> . UNAIfIF7(]4fZFDRELEASE EVALUATION FEE . = S 93/HOUR <br /> SAMPLING WSPECTION FEE = S 93/HOUR - .. = .-.... $ I. <br /> 'AtLFEES"ARE BASEDOff THE S93 HOURLY RATE iSfETHATMELDS FEES PAM YPtLE3E641ED'TO APPLICAtIL ... <br /> OFFICE USE ONLY <br /> - - t <br /> - .. I SERVICE tREOUEST 9 FACAJTYtD I CHECKS ' :. REC81IED 81/ OATE R(3UNM . I <br />