Laserfiche WebLink
SAN JOAWfM CQJMTT PUBLIC HEALTH SERVICE( <br /> �u <br /> ENVIRONMENTAL HEALTH DIVISION , <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE VCRKSHEET <br /> FACILITY SITE NIDE Sc; FACILITY CONTACT MANE <br /> A !�'�✓P�/ -nvhi/P . /03 Z.24,C</ R <br /> I FACILITY ADDRESS SITE PHONE f with AREA CCDE - <br /> a/ o/ G. C< .rle, CJ C> - 9 - /071 <br /> T CITY STATE ZIP CODE If of TANKS <br /> T J1D c/c1F/-s1 4S at SITE l <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P r' <br /> �tOr <br /> L 2. <br /> I NAILING ADDRESS APPLICANT PXCNE ! WITH AREA CODE <br /> C <br /> A STATE 2IP =1 TYPE of APPLICATION <br /> T CETT OLD SUN1, INSTALLATION, ate. <br /> T <br /> i Oe^a T1 c5 TOTAL <br /> A 4�nqf � <br /> C lMalA.LdArA. 19"6 IT 196f._ 1982 1990 . <br /> T ANNUAL FACILITY FEE (Prior to January 1, 19913 • 5100 <br /> 1 ! V O f 8rpp <br /> v <br /> TANK FEE • 250.00/TANK (prior to JarI ry 1,1991) 21 AN5 after January 1, 1991) <br /> F s Tanks • —L 19"0= 1987/ 196E 19"9 1990 1991 1992 1945 1996 1995 <br /> A (snip); F4—tty fee for �,. <br /> each year aplteable) , SC YO <br /> t <br /> L STATE SURCHARGE • $56.00 each TANK (Due ovary S years) Sea Call}ornta N i S Code, Saecten 25287 <br /> T 0 Tanks/ X 556.00 1966 through 1990 1991 through 1996 <br /> Y (enter AMO nt and year) <br /> PERMANENT CLOSURE (Removal or Autfiorltad Closure-tn-Plaoa) FIA I.D. /(U <br /> C <br /> L CLOSURE FEE • 153.00 per hour (5 hours atniaaaa per TANK) NK(f)_ X9.00 • 0� <br /> LOWELL RATHE 4364 <br /> MOBILE HOMES, INC. <br /> 2101 E. CHARTER WAY 948-1077 <br /> STOCKTON, CA 95205 <br /> 1 <br /> v PAY <br /> TO THE <br /> 96t2oAARS <br /> UNION SAFE <br /> DEPOSIT BANK - - <br /> �tJgN.EIOwwA a G1 <br /> •••••, ,••.• ••• .• TOTAL DUE S /(cso7-CJO <br /> OFFICE USE MY <br /> reC, =^ 'bT>'!'c AaClfi':(!U� " J��34tr �al�'ST�r "ff�' r <br /> EiYcEG7CL11 _ O/ j±3. <br /> C <br /> -.rc_co�coccc— .occ�o�s_ocooc._csoocco_- <br /> �..�r�ra.rrr•r��r�rrs �ara>.rsrr�rsrr•r�rrrar r�rr�r•rrarr•rrr�nrr <br /> E9 23 032 (REV </6�11`f� } �` � "7 �� Pam 11 �� <br />