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0 0 <br />SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />UNDERGROUND STORAGE TMK PROGRAM FEE WORKSHEET <br />FACru i Y NAME <br />FACILITY CONTACT NAME <br />ELITE IV CONTRACTORS, INC_ <br />CARRIE-MILLER <br />FACILITY <br />SITE PHONE � WITH AREA CODE <br />[A�DDR,tE�SS <br />'.J 7 /1" 6�. —"�t�E <br />LsCJ� �%� �c� ^-- Y C� S� - - <br />CITI'. <br />STATE <br />ZIP CODE <br /># OF TANKS AT SITE <br />,S C)C tCrO t4 <br />CA <br />1Sg-21Z <br />$ <br />APPLICANT SILTING 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 />STO,CKTON <br />CA-- - <br />95205 <br />ACTIVE FACILITY <br />TANK tD # (s) :. CLOSUZE FEE =_$279 PTANK <br /># TANKS X $279 = <br />1998 " <br />1999" <br />2000 <br />2001 _ <br />2002 <br />2003 <br />_ $500 FEE INCLUDES FACILITY FEE:G- 1 TANK - <br />(ano)x (ma A-) <br />UNAUTH RLZED RELEASE EVALUATION FEE . _ $ 93 ! HOUR <br />$ <br />SAMPLING ASS'PECTION FEE = S 931 FLOUR <br />$125.PER TAW AFTER FIRST TAW <br />• <br />$ <br />TANK PEMAL.TYASSESSED <br />_ <br />TANK SURCHARGE _ $101 TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVEWORY IN A CUPA PROGRAM=$17.Wd FACILITY <br />PERMANENT CLOSURE <br />Removal or. Ckrwein Place `- <br />TANK tD # (s) :. CLOSUZE FEE =_$279 PTANK <br /># TANKS X $279 = <br />TEMPORARY CLOSURE <br />(Purl Review and Insped5ons) <br />TANK ID .0 (s): <br />TaVORARY CLOSURE FEE _ $2791 FACILITY . <br />INSTALLATION PLAN CHECK <br />(Pian Cited: and Construction Inspections) <br />TANK ID 4 (s) : <br />REPAIR PLAN CHECK <br />TANK ID 17 (s): <br />TANK -RETROFIT REPAIR FEE _ $2791 FACILITY fuse for <br />PIPINGREPAIR FEE =S2791 FACILITY (ase for <br />PLAN CHECK FEE _. $7441 FACILITY <br />t9 equipment spill buckets. Yank sumps. mirsc} <br />ndel- sIi zser containment ect) <br />MISCELLANEOUS <br />$. <br />TRANSFER FEE _ $ 20 <br />$ <br />-CONSULTATION FEE : _ $ 9N HOUR <br />$ <br />UNAUTH RLZED RELEASE EVALUATION FEE . _ $ 93 ! HOUR <br />$ <br />SAMPLING ASS'PECTION FEE = S 931 FLOUR <br />ti � •, .arras . �•st • � . , :. r ., <br />_�• h '. • +.. ,.... • . w7 �1... w: dew A_Ma� /Q• =f • ,.... l�w� • <br />