Laserfiche WebLink
STREET ADDRESS law <br />S r l/Il.✓ <br />SITE PHOME I WITH AREA CODE <br />Y ctrr — — ��Y <br />ST,e_lr �� STATE IIP CODE 1 of Tanks <br />-- <br />pq'rcLat Site T��✓ <br />AAPPLICANTFBILLINIG NAME-•------_.._..._--___._.__- _-.___,___,_. _ ,_. <br />P APPLICANT CONTACT NAME <br />L <br />I MAILING ADDRESS -- _._..___ _ .-_. __.`. 1 !__ vU •_1 ` <br />i APPLICANT PHONE I WITH AREA CODE <br />ee n <br />SjATE1 IIP CODE TYPE Of APPLICATION — <br />�F S, h) CLOEUof INDICATION Eft�A <br />—_--" i� <br />FACILITY FEE = 1100.­SITE 00 each DDRESS per <br />- - - --- <br />p.._.._,_--_--_._—_-- <br />C 1386 1987 1388 1989 <br />E TANK. FEE = • (50.00 each TANK <br />F I Tanks x 150,00 <br />A (aultipaafee for <br />C eaih year <br />r appp011cable) •�--.-"'--_—_-___._.__..—.________�_— -- — - <br />L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25287 for applicability) <br />_ <br />i I Tanks x (56.00 1988 — -' <br />Y (enter iiuiit and year) ^1386- �-1381 - <br />C PERMANENT CLOSURE (Removal Or Closure-in-place) --- <br />0 CLOSURE FEE = 190.00 each TANK ---- <br />S --- _---- I Tanks pZ x 190.00 1—Q/� 00 <br />D--- —_---. <br />E DATE INVOICE AMOUNT <br /> <br />2735 TEEPEE DR. SUITE E <br />STOCKTON,CA 95205 <br />P (208) 848-6124 10053 <br />05' <br />L <br />14' <br />SII PAY <br />L_ <br />DATE DOLLARS <br />T THE ORDER C caoss ANourvr <br />f �� �3 or«[s Acos. PArAe [ O SCOUNT CHECK AMOUNT <br />F. <br />E <br />F <br />WESTERN METER SERVIC NC. <br />UNION SAFE DEPOSIT BANK / v <br />F STOCKTON, CALIFORNIA <br /> <br />OFFICE USE ow - <br />�i���uu�uuuuu�iuu0unuuuuuu��u�uu��muuuu�mmiu��fluimimuuuuuuuuuuu�flu�auuuuuuuuuuuuuuuuiu�uimiuuuuuuuuuuu�iuimuaimiiuuuuiu���muuuuuuiuiuuuuumuuuiuiuuiu��uunlrunimuuuium�uuouuuu��unn��uuuui <br />COMP I LDL COOE GIST CODE AMOUNT DUE AMOUNT Rr,VO CHECK /CASH PCvO DY DATE PECEIVEO PEPnIi <br />/Oiot HAfiJvl/ Q/ 3:t/ /frnQO fh <br />