Laserfiche WebLink
SAN J )UIN COUNTY ENVIRONMENTAL HEALTH C ,RTMENT <br /> UNDERGRO�,,Z STORAGE TANK PROGRAM FL` WORKSHEET <br /> FACILITY NAME FACILITY CONTACT NAM Iff— <br /> FACILTrYADD5nS, SITE PHOW#WITH AREA CODE <br /> CITY STATE ZIP CODE #OF TANKS AT SITE <br /> CA <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 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 ($170)x(#tanks) ($170)x(#tanks) <br /> $125 PER TANK.AFTER FIRST TANK <br /> ( TANK s:NAL1-fF. SESSED $ <br /> TX 6URCHARGE=$10/TANK $ <br /> A` <br /> J STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM=$17.50/FACILITY $ <br /> FPER ',UIF#'T R,- <br /> Removal or Permitted Closure in Place <br /> TANK ID#(s): _— _ CLOSURE FEE=$279/TANK j #TANKS X$279= <br /> TEMPORARY CLO:iURE — <br /> r1s1t Re Jew and Inspections) <br /> TANK PD#(s): $ <br /> TEMPORARY CLOSURE FEE_$279/FACILITY <br /> INSTALLATION n?,AN CHECK <br /> (Plan Check and .�onstructior,Inspections) <br /> TANK ID#(s): PLAN CHECK FEE=$744/FACILITY $ <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE _$279/FACILITY (use for monitoring equipment,spill buckets,tank sumps,misc.) cx / <br /> PIPING REPAIR FEE =$279/FACILITY (use for piping,under-dispenser containment,ect.) $ <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $20 _ $ <br /> CONSULTATION FEE _ $93/HOUR $ <br /> $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE _ $93/HOUR <br /> SAMPLING INSPECTION FEE _ $93/HOUR $ I <br /> ALL FEES ARE BASED ON THE$93 HOURLY RATE. TIME THAT EXCEEDS FEES PAlD WILL BE BILLED 70 APPLICANT. <br /> OFFICE USE ONLY L <br /> SERVICE REQUEST# FACILITY ID AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> I <br /> SR <br /> EH 23 032(REVISED 8/01103) <br />