Laserfiche WebLink
OCTECEIVED <br /> r1i, 'A SWAMI �� <br /> —COUNTY <br /> drectness Cfows here, <br /> FACILITY NAME ACT NAME <br /> FACILITY ADDRESS SITE PHONE#WITH AREA CODE <br /> 975 S. Fairmont Ave 209 334-3411 <br /> CITY I STATE ZIP CODE #OF TANKS AT SITE <br /> Lodi CA 195240 <br /> APPLICANT BILLING NAME APPLICANT CONTACT NAME <br /> Elite IV ContractorsCarrie Miller <br /> APPLICANT MAILING ADDRESS APPLICANT PHONE#WITH AREA CODE <br /> 2535 Wigwam Dr 209 461-6337-Call 993-4267 <br /> CITY I STATE I ZIP CODE CIRCLE WORK TO BE DONE I CONTRACTOR ICC# <br /> CA 195205 Closure Installation Repair Retrofit <br /> ACTIVE FACILITY <br /> UST FEES= $641 Facility Fee+$152 Per Tank 2012 2013 2014 2015 2016 1 2017 <br /> TANK PENALTY ASSESSED <br /> TANK SURCHARGE=$20/TANK <br /> $ <br /> STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A COPA PROGRAM=$49.00/FACILITY <br /> PERMANENT CLOSURE <br /> Removal or Permitted Closure in Place <br /> $ <br /> TANK IO# s : CLOSURE FEE=$456/TANK I #TANKS X$456= <br /> TEMPORARY CLOSURE <br /> Plan Review and Inspections) <br /> TANK ID#(s): TEMPORARY CLOSURE FEE_$456/FACILITY $ <br /> INSTALLATION PLAN CHECK <br /> Plan Check and Construction Inspections) <br /> $ <br /> TANK ID#(s): PLAN CHECK FEE=$1216/FACILITY <br /> REPAIR PLAN CHECK <br /> TANK ID#(s): <br /> TANK RETROFIT REPAIR FEE =$456/FACILITY (use for monitoring equipment,cold starts,EVR upgrades, <br /> spill buckets,sumps,mise. <br /> PIPING REPAIR FEE=$456/FACILITY use for piping,under-dispenser containment,act. $456.00 <br /> MISCELLANEOUS <br /> TRANSFER FEE _ $25 $ <br /> CONSULTATION FEE = $152/HOUR $ <br /> UNAUTHORIZED RELEASE EVALUATION FEE = $152/HOUR $ <br /> SAMPLING INSPECTION FEE = $152/HOUR $ <br /> FEES ARE BASED ON THE$162 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> TOTAL AMOUNT DUE Is <br /> OFFICE USE ONLY <br /> SERVICEREQUEST# 1 FACILITY to AMOUNT RECEIVED CHECK# RECEIVED BY DATE RECEIVED <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209464-0138 1 www.sjcehd.com <br />