Laserfiche WebLink
Nov 21 14 02:39p Elite Iv Contractors Inc 20946 142 <br />p.4 <br />RECEIVELJ <br />SAN .%gQuiit counr7'Y R <br />EWIR0NMTNTALHCA..LTHDEPARTMENT NOV 220 4 <br />1868 E. Flazelton Ave„ Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: wA wAcehd-oom <br />APPLICANT (WAILING ADDRESS APPLICANT PHONE # WIT+H AREA CODE <br />;•j <br />7'X '7 STATE ZIP CODE CIRCLE WORK TO RE DONE CONTRACTOR ICC # <br />Installation R it R,b tit <br />$550 FEE INCLUDES FACILITY FEE + 1 TANK <br />$130 PER TANK AFTER FIRST TANK <br />TANK PENALTY ASSESSED <br />TANK SURCHARGE = $151 TANK <br />$TATE SURCHARGE FOR FACILITIES NOT <br />2010 1 2011 12012 12013 •1 2014 <br />IN A CUPA PROGRAM =$35.00/ FACILITY i $ <br />PERMANENT CLOSURE,.. <br />Romaral or PFxrnilted Closure In Plane <br />TANK ID 7f (s): CLOSURE FEE = $3901 TANK <br />TANKS X $3911 <br />TEMPORARY CLOSURE <br />Plan Review and Inspections) <br />TANK ID # (s) : <br />TEMPORARY CLOSURE FEE = 3901 FACILITY <br />TANK ID # (s) <br />PLAN CHECK FEE = $10401 FACILITY <br />REPAIR PLAN CHECK <br />TANK If) # (s) <br />CONSULTATION FEE _ $130/ HOUR <br />$ <br />TANK RETROFIT REPAIR FEE = $3901 FACILITY (use for moniloiing equipment, coldJstarts, EVR upgrades, <br />$ <br />Will buckets, sumps, mist. <br />$ <br />$ <br />PIPING REPAIR FEE = $3901 FACILITY use for piping. under-dis ensorcontainment cct <br />MISCELLANEOUS <br />TRANSFER FEE _ $ 25 <br />CONSULTATION FEE _ $130/ HOUR <br />$ <br />UNAUTHOR17.FO RELEASE EVALUATION FEE =$130/HOUR <br />$ <br />$AMPLING INSPECTION FEE _ $ 1301 HOUR <br />$ <br />rVU4 AMC wWcu V. tnG #14Y nVViG.i rcn1C 1(gIC 1nAl GAVLCV3 rCCia YAW YYI" tlL WLW.;V 1W At -V %-PJ4 1. <br />TOTAL AMOUNT DUE $ <br />OFFICE USE ONLY <br />SERVICE REQUEST # FACILITY ID AMOUNT RECEIVED CHECK # RECEIVED BY DA7l: RECt:1Yt17 <br />