Laserfiche WebLink
SAN UIN COUNTY ENVIRONMENTAL HEALTH D*TMENT <br />UNDERGR D STORAGE TANK PROGRAM FEE WORKSHEET <br />cero ITV ►rAu= <br />A DDI rr Ar.rr Du I I - <br />IV CONTRACTORS, INC. <br />rAC1U <br />I Y CONTACT NAME —� <br />(tic C) <br />IGWAM DRIVE <br />Fa <br />FACILITY ADDRESS <br />PHONE - <br />SITE W AREA CODE <br />CITY <br />ZIP CODE TO BE DONE: <br />i'. <br />- <br />C17( STATE <br />ZIP CODE # OF TANKS AT SITE <br />CA <br />q <br />A DDI rr Ar.rr Du I I - <br />IV CONTRACTORS, INC. <br />ArrUCAN I CONTACT NAME <br />CARRIE MILLER <br />FAPPUCANT AILING ADDRESS <br />APPLICANT PHONE #WITH AREA CODE <br />IGWAM DRIVE <br />2002 <br />2003__-- <br />(209) 461-6337 <br />CITY <br />ZIP CODE TO BE DONE: <br />LSTATE <br />STOCKTON CA <br />=CIRCLERK <br />95205tion <br />Repair Retrofit <br />ACTIVE <br />$504 FEF INCLUDES FACILITY FEE +.1 TANK- <br />$125 PER TANK AFTER FIRST TANK <br />1998 <br />(S170) X manks <br />1999 <br />2000 <br />2001 <br />2002 <br />2003__-- <br />TANK PENALTY ASSESSED <br />$ <br />TANK SURCHARGE = $10 / TANK <br />$ <br />STATE SURCHARGE FOR FACILITIES NOT ALREADY ON INVENTORY IN A CUPA PROGRAM =$17.507 FACILITY <br />$ <br />femoral or Pem:itted Closure in Place' <br />TANK ID # (s) :CLOSURE FEE = $279 / TANK # TANKS X,;279 <br />= $ <br />TEMPORARY CLOSURE <br />(Plan Review and Inspections) <br />TANK ID #(s): __ -- --- ---- - r$ <br />_ T <br />INSTALLATION PLAN CHECK T _ <br />(Plan Check and Construction Inspections) <br />TANK ID f1 (s) <br />REPAIR PLAN CHECK <br />TANK ID # (s) : <br />TANK RETROFIT REPAIR FEE = $279 / FACILITY (use for <br />PIPING REPAIR FEE = $279 / FACII ITY I—. f-, <br />TRANSFER FEE _ $ 20 <br />CONSULTATION FEE _ $ 931 HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE _ $ 93 / HOUR <br />SAMPLING INSPECTION FEE _ $ 93/ HOUR <br />ALL FEES ARE BASED ON THE $93 HOURLY RATE. TIME THAT EXCEEDSI <br />OFFICE USE ONLY <br />PLAN CHECK FEE = $744 / F <br />C? <br />it_spill buckets, tank sumps, misc.) $ <br />ser containment, ect.) $ <br />LL BE BILLED TO APPLICANT. <br />SERVICE REQUEST #FACILITY 1D AMOUNT RECENED CHECK # RECENED BY, DATE RECEIVED <br />SR <br />EH 23 032 (REVISED 8/01103) <br />