Laserfiche WebLink
SAN 'QUIN COUNTY ENVIRONMENTAL HEALTH I \RTMENT <br />UNDERGR,. JND STORAGE TANK PROGRAM FEC WORKSHEET <br />FA [LE I NAME <br />APPLICANT CONTACT NAME <br />FACT ITY CONTACT NAME <br />CARRIE MILLER <br />IFACILITY <br />� <br />I o <br />(Min/ <br />j <br />AD RESS <br />STATE <br />HON # AFFTW AR <br />ODE <br />STOCKTON <br />CA <br />95205 <br />CITY <br />STATE <br />ZIP CODE <br />## OF TANKS AT SITE <br />C <br />CA <br />APPLICANT BILLING NAME <br />APPLICANT CONTACT NAME <br />ELITE IV CONTRACTORS, INC_ <br />CARRIE MILLER <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE # WITH AREA CODE <br />2535 WIGWAM DRIVE <br />(209) 461-6337 <br />CITY <br />STATE <br />ZIP CODE <br />CIRCLE WORK TO BE DONE: <br />Closure' Installation Repair Retrofit <br />STOCKTON <br />CA <br />95205 <br />ACTIVE FACILITY <br />TANK ID ## (s) : CLOSURE FEE _ $279 /'TANK <br />E# TANKS X $279 = <br />1998 <br />1999. <br />2000 <br />2001 <br />2002 <br />2003 <br />$500 FEE INCLUDES FACILITY FEE + I TANK <br />($170)x(#tanks) <br />IS 170) X (V%nks) <br />$ <br />- --- <br />S125 PER TANK AFTER FIRST TANK <br />$ <br />_TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $10 /TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$17.50/ FACILITY <br />j PERMANENT CLOSURE <br />Removal or Permitted Closure in Ptace <br />TANK ID ## (s) : CLOSURE FEE _ $279 /'TANK <br />E# TANKS X $279 = <br />TEMPORARY CLOSURE <br />(Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE _ $279 / FACILITY <br />. R'� IJALAG <br />LIIUN PLAN UHtK <br />(Plan Check and Construction Inspections) <br />TANK ID ## (s) : -- - - PLAN CHECK FEE = $744 / FACILITY <br />REPAIR PLAN CHECK <br />TANK ID # (s): <br />$ <br />TANK RETROFIT REPAIR FEE _ $279 / FACILITY (use for monitoring equipment, spill buckets, tank sumps, misc.) <br />$ <br />PIPING REPAIR FEE = $279 / FACILITY (use for piping; under�dispenser containment, ect) <br />$ <br />MISCELLANEOUS <br />$ <br />TRANSFER FEE _ $ 20 <br />' <br />$ <br />CONSULTATION FEE _ $ 93/ HOUR <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 931 HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />­4ua nvur%L r r%Al G I IMC 1 nAl C1ll,ttUJ![tJ PAID WILL tit bU-LtU I V APPLICAN 1. <br />OFFICE USE ONLY <br />SERVICE REQUEST It FACILITY ID AMOUNT RECEIVED CHECK #t RECEIVED BY DATE RECEIVED <br />SR <br />EH 23 032 (REVISED E/01/03) <br />