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AIL <br />SAJOAQUIN COUNTY EWRONMENTAL HEALTH IWARTMEW <br />UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br />FA ILE ill NAME <br />FACILITY CONTACT NAME <br />Gt I Zam 10 a_r �� <br />FACIILLfTY ADDRESS <br />Pch, .Nn <br />srYE PHONE # WITH <br />AREA CODE <br />CITY STATE <br />(OTI <br />Z1P CODE <br /># OF TANKS AT SITE <br />CITY STATE <br />Z1P CODE CIRCLE WORK TO BE DONE: <br />STOCKTON _ CA" <br />95205 <br />Closure' Installation Repair Retrofit <br />CA <br />5 �� <br />' TANK PENALTY ASSESSED <br />• "•" "•� ^_ <br />ELITE IV CONTRACTORS, INC_ <br />APPLICANT CONTACT NAME <br />CARRIE MILLER <br />APPLICANT MAILING ADDRESS <br />APPLICANT PHONE X WITH AREA CODE <br />2535 .WIGWAM DRIVE <br />2000 <br />2001. <br />(209) 461-6337 <br />CITY STATE <br />Z1P CODE CIRCLE WORK TO BE DONE: <br />STOCKTON _ CA" <br />95205 <br />Closure' Installation Repair Retrofit <br />ACTIVE FACILITY <br />$ <br />$500 FEE INCLUDES FACILITY FEE + -1 TANK - <br />$125.PER TANK AFTER FIRST TANK <br />1998 <br />w7o)x (M-nkl ) <br />1999. <br />2000 <br />2001. <br />2062 <br />2003 <br />' TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE _ $101 TANK <br />$. <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$17.5W FACILITY <br />$ <br />INSTALLATION PLAN CHECK <br />(Plan Check and Construction Inspections) . <br />TANK ID 11 (s) : PIAN CHECK FEE _ $744 I FACILITY <br />REPAIR PLAN CHECK <br />TANK IDJ7 (s): <br />TANK.RETROFIT REPAIR FEE _ $279 / FACILITY (use for monitoring equipment, spill buckets, tank sumps, mise) <br />PIPING REPAIR FEE =$279/ FACILITY (use for piping; under�ciispeiiser containment ecL ) $ <br />MISCELLANEOUS <br />I <br />TRANSFER FEE _ $ 20 <br />$ <br />CONSULTATION FEE : _ $ 93/ HOUR - <br />$ <br />UNAUTHORIZED RELEASE EVALUATION FEE . _ $ 93 ! HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ 93! HOUR <br />et 9tAQrr%nu TUC C., <br />$ <br />OFFICE USE ONLY <br />