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AILIC <br /> / TAN JOENVIN ENVIRONMENTAL <br /> PHEALT HEALTH SERVICE! 1 <br /> '✓,/J ENVIRONMENTAL NEALiM DIVh1011 <br /> UN�oUND STORAGE TANK PROGRAM - FEE VORKSNEET <br /> 7FACWTV MANEFACILITY CONTACT NAME <br /> a Bay Farm Credit Service Eliot Appleton <br /> CSITE PHONE 0 with AREA CODE <br /> 1 RESS 11273 E. Ada Ave. (209) 931-3770 <br /> L <br /> 1 <br /> 1 CITY STATE 21P CODE ! of TANK4 <br /> Y Stockton, Ca. 2 to 11tE <br /> A APPLICARt/lILLINO NAME APPLICANT CONTACT MANE <br /> P Sierra Bay Farm Credit Service Same as above <br /> P i <br /> L APPLICANT PHONE N VITH ANSA CODE <br /> I MAILING ADDRESS <br /> C Po. Bx. 8070 20 - <br /> A <br /> M [ITT sIATE �j20CCOE TYPE of APPLICATION Removal <br /> T Stockton, a. 7 ti ctosUDE, INSTALLATION, etc. <br /> TOTAL . <br /> A 1986 1987 1988 1989 1990 <br /> C <br /> 1 ANNUAL FACILITY FEE (Prior to January 1, 1991) • 1100.00 1 <br /> I <br /> V <br /> E TANK FEE • 150.00/1ANK (prior to January 1,1991) - 11170/LANK (after Je(e/ery 1, 1991) <br /> 1 <br /> F f Tanks • 1986 1907 198(1 1989 t990 199) 1992 1993 1994 (995 1996 <br /> A (MItlply ITiy-fee for ! { <br /> c each year opplleeble) <br /> I <br /> L STATE SURCHARGE • 156.00 each TARK (Due every 5 years) See California N t$ Cedo, Section 252871tanks ■ 156.00 1986 through 1990 1ufh 1996 <br /> T (inter amount and year) 1 II <br /> I <br /> PERMANENT CLOSURE (Removal or Authorized Closure-in-Place) TANK I.D. Va) <br /> L CLOSURE FEE • 153.00 per hour (3 hours minimum per TANK) 0 TANK(e)__ X 1159.00 - 1 159.00 <br /> RICH -MARC I M 5 <br /> JIM THORPE, DISTRIBUTOR OF QUALITY PRODUCTS <br /> - -- - - - 368-6175 482-4581 <br /> /4113 e- 4;---- -- 351 NO. BECKMAN ROAD, P.O. BOX 357 <br /> --- — LODI, CA 95241-0357 <br /> ii- - -- PAYTOT E <br /> ORDER /!l ) Z44 <br /> II - -- l.�lltiesL' l4JT DOLLARS <br /> �ckto1001 Offla <br /> n <br /> <br /> � <br /> c FEE • 153.00/hr FEE • 153.Oo/hr rcc • s ».wnn _ <br /> �/ �_� A� r.[tD�U[L DUE-/� !159.00 <br /> OFFICE USE ONLY Q uttW 102C KT[(,)t.WL A9 I�I�"'I�I " PS <br /> ',.ww"SJiS $Y gggs— <br /> �,YSP•'�ii i,iaarrr•nnwrr waw wa,,,,iiC,Yiwr wwwiaiiwiiiiw`7a •moi waii,'iFiA",wA-ea`ae GSNVOMM <br /> i aw;== 9 r 2I}lE" "bISTL�fE'" Afi�ifm T'!1C'NMrsa 71�L4'ftlElf"U4 M �NTJEIf"" <br /> 3 s/Ea / 0 <br /> WMAMINwNOW Ariarwawarri,.ar innwrwwwrwwirwwr-EL 'iiwwwwww�ii>Ciiw�i <br /> YswllwgaMM MM MMfMMaMMMM M,My MaesipEaMME MeMMMMMM•IMMMMM Me Maes MMMMMMMMMMYMMaMMaMMMMaMM <br /> EN 23 012 (REV t/10/911 it Pace 1 <br />