Laserfiche WebLink
SAN J IN COUNTY ENVIRONMENTAL HEALTH D RTMENT <br /> UNDERGROWD STORAGE TANK PROGRAM F WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAME <br /> F c o v Y�lc. <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 1 5o o o f y 6 -S3s <br /> CITY <br /> 1 STATE ZIP CODE #O TANKS AT SITE <br /> 6.� 10cy, CA s.2U,7S- <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> ELITE IV CONTRACTORS, INC. CARRIE MILLER <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 2535 WIGWAM DRIVE ( 209) 461 -6337 <br /> CITY STATE ZIP CODE I CIRCLE WORK TO BE DONE: <br /> STOCKTON CA - 95205 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> 1998 1999 2000 2001 2002 2003 <br /> $500 FEE INCLUDES FACILITY FEE+1 TANK (sm)X(wanes) (6170)X(manim) - <br /> ' $125 PER TANK AFTER FIRST TANK <br /> TANK PENALTY ASSESSED $ <br /> TANK SURCHARGE=$10/TANK $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$17.50/FACILITY $ <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place ' <br /> TANK ID#(s): CLOSURE FEE=$279/TANK #TANKS X$279= $ <br /> TEMPORARY CLOSURE <br /> (Plan Review and Inspecfions) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE_$279/FACILITY $- - <br /> INSTALLATION PLAN CHECK <br /> (Plan Check and Construction Inspections) <br /> TANK ID#(s): PLAN CHECK FEE_$744/FACILITY <br /> .� <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$279/FACILITY (use for monitoring equipment,spill buckets,tank sumps,misc.) 1 / <br /> PIPING REPAIR FEE =$279/FACILITY $ <br /> (use for piping,under-dispenser containment ect) i <br /> MISCELLANEOUS. <br /> TRANSFER FEE _ $20 $ <br /> CONSULTATION FEE _ $93/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $93/HOUR <br /> SAMPLING INSPECTION FEE _ $93/HOUR $ <br /> ALL FEES ARE BASED ON THE$93 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT, <br /> OFFICE USE ONLY <br /> SERVICE REQUEST# j FACILITY ID AMOUNT RECEIVED I CHECK II I RECEIVED BY DATE RECENED <br /> SR <br /> EH 23 032(REVISED 8/01/03) <br />