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SAN Amu cmmTY KnLIC HEALTH SEXnCES - OWIRCw6a AL ffaLM OnSION <br />WUXMM 3TMAGS TANG P200/IM - FI5 YURK ZQI�.:T <br />$FACILlrT <br />$ITE. U06 <br />FACE LITT MR TACI HAW <br />{ <br />� Esq .yit3r <br />�AT"itff#A'i <br />T <br />'E <br />rACILiif ADDRESS <br />SITE PHONE # vich AREA CAE <br />A <br />CI 3TA5E <br />Z2P Cc)dE <br />at rala KS <br />A <br />I <br />a <br />to <br />az r <br />t4$8 15+89 1990 1911 1442 f� <br />[94319W. 1945 i94h 1997 3456 <br />i <br />F <br />P <br />-- <br />APPLiCANTISIL ING SANE <br />APPLICANT CONTAC MMANE <br />L <br />� _ A) - ke-4 <br />3°r{1R Sfsn <br />I <br />G <br />MAILING ,AOORESS <br />APPLICRMT AHM5 9 WITR AREA CEDE <br />L' <br />I <br />11 <br />STATE MRClARrx FOR NEV PACILITI€5 ONLYt*1$.50 <br />N <br />T <br />CITY STATE <br />ZSF CAGE I rvo of Appum--rim <br />I943 through 1947 CS�67 ma <br />G fGid <br />cf53 & (CCasure, Installation, Arc-) <br />i TOTAL <br />WAIR FEE (uotkptan RevieW A CanstrECtian In8peC-,70W) � -LAU I.J. AS) _ <br />TAMC LINING REPAIR 1 = 378-00fhovr (3 hautS akiniAW(TANC) TANK{S7 �- X S .QOFEE = <br />19%� 148T � 19y36 7485f � T944 <br />;pylic RZ;RaFTT REP4U2 FE=- = 578-JOfhour (3 hours xin./FACIUM = S734-00 mining <br />ANNUAL FACILITY FEE (Prior t13 datasrY t, t59t7 =5100-00 <br />)(ACG 7000( 7000( JOOLY x7001 <br />S 7dIXXJ= <br />A <br />C <br />T <br />FACiLIT1' PCNALTY FEES ASSESSED (If AWOCHtKe) <br />XX7fX xxxx wx )0= )L;= <br />3 70X ( <br />I <br />a <br />TAW r"ac S50.00/TANK (friar to Samary 1,1941)I <br />3170lIARC (Afrer lam,tY t, 19(91) <br />t4$8 15+89 1990 1911 1442 f� <br />[94319W. 1945 i94h 1997 3456 <br />i <br />F� <br />A.1 <br />u���IY $ � fe- For <br />amth year appt i cable) xXXX 7q X I xx)U(} ! <br />S <br />C <br />I I <br />TANK PENALTY tE=-S ASSUSEJ i =cc =(x � =cx � x:= �wx <br />f <br />L' <br />I <br />11 <br />STATE MRClARrx FOR NEV PACILITI€5 ONLYt*1$.50 <br />S <br />T <br />7J <br />;;TartkS� x 58.00 I 19M thraugin 1943 (5567 <br />I943 through 1947 CS�67 ma <br />$ <br />51ACHARGc FOR 1998 <br />cl ?ERIaANEtT C'_DSURP (tlenwat or Aurhoriz%d C;asurE-i Pfsce) I <br />TANK C.d_ A%) <br />L� <br />0l <br />+Cl=PE F r' -e S%8.401hcur C hours minivam/TAUK) <br />9 TANK(al x s 34.Co <br />s <br />Vj <br />TEMF'4RART' CLOSI,IRC (?!an 3p11eu & IftCP*C_i*w) { <br />'TANK I.D. Asl _--- __-- <br />i <br />R <br />El <br />TqPORARY cLcsme fe£ = S78.M/haur C3 hours minimwlFACrLITY) <br />5734.00 miniaum <br />S <br />P <br />INSTALLATION PLA1c CIIC-CC :Plan Rewicw S ;:4=truc-.ian tra eceions)� <br />TANK I.O. SKsl <br />L <br />A <br />M <br />PLu CeEX FE--' - S78_001how t11 i' mm winimWr-ACIUM <br />�S624.W mntem <br />S <br />WAIR FEE (uotkptan RevieW A CanstrECtian In8peC-,70W) � -LAU I.J. AS) _ <br />TAMC LINING REPAIR 1 = 378-00fhovr (3 hautS akiniAW(TANC) TANK{S7 �- X S .QOFEE = <br />S <br />;pylic RZ;RaFTT REP4U2 FE=- = 578-JOfhour (3 hours xin./FACIUM = S734-00 mining <br />Pi4IxG Rj-?AIR miniakWFACIUTT) $734.00 miniww <br />5 <br />MI TRANSFER AEE = =.m ! ! UWAUnKRI7.$) RFIZA'SE U UTATIGN s76.OWhr 5 <br />i i { <br />S <br />C CONSUL'rATIOt! FEE = 576.00/hr � � SAMPLU16 INSAEGTICM P-- = 37H.DQ/trr � 8 <br />TQ AL ME <br />ATG-�r.'t <br />i 23 032 CRWSO t-12-981 <br />U/ 'd 6666'oN X i-�U-60Z Nd�9:z 6661 11 'Unr <br />