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ta�,pA01JIN COUNTY rALIC HEALTH SERVICES <br /> ERVI�ENiANKNPRL�AMIVISIOIfee NCIIKSNEET <br /> UNDERDROAIO <br /> FALILl1T CONTACT HANE <br /> FACILITY $119 NAMEWalter Williams <br /> Walter Williams Y Nl th AREA CODE <br /> F <br /> F SITE PHONE <br /> C 20 )368-288 <br /> I FACILITY ADDRESS t7700 N. Kennison Ln. 0 of TANKS <br /> L fCa. 95240E .t SITE 1 <br /> T CITY Lodi, APPLICANT CONTACT MANE <br /> Y <br /> A APPLICANT/111T.1.1114 NAME Richard Thorpe <br /> P Same as above APPLICANT PHONE Y Will AREA CODE <br /> P <br /> L Same as b <br /> I NAILING ADDRESS IYPEof APPLICATION Removal <br /> C STALE 21P C16 CLOSURE, INSTALLATION, at(,• <br /> A <br /> R city - TOTAL <br /> T �--- <br /> 1986 1987 1988 1989 1990 ---- <br /> A1. <br /> A • $100.00 <br /> I $ <br /> I ANNUAL FACILITY FEE (Prior to JeraSary 1, 1991) <br /> $170/TANK (attar January 11 1991) <br /> Y $50.00/TANK (Prior to JawarY 1,1991) 1994 I995 1996 <br /> E LANK FEE . <br /> 1956 1967 1988 1969 1990 1991 1992 199 $ <br /> F Y tanks • j by fee for <br /> A (.ultlpW Ilwhle) Section 25287 <br /> C each year app een) Sea California N S S Coda, <br /> 1 556.00 arch TANK (Due every 5 Y 1991 through 1496 <br /> L STATE SLRCNARGE 1986 through 1990 $ <br /> K $56.00 <br /> 7 Y Tanknd year) - <br /> (inter amount a <br /> TANK I.D. Y(s) <br /> PERNAHENT CLOSURE (Removal or Authorlxed Llosure-In-Pl ace) 1 Y TANK(S) K $159.00 $ 15 -007 <br /> C . $53.00 per hour (3 hours mini" per IANK) _� <br /> L CL05URE FEE <br /> 0 — 1 <br /> — <br /> -RICH'MART QUALITY PRODUCTS <br /> DI9TRIBUTOR'or, -• <br /> i JIM THORPE. 368 6175 <br /> R6175 462-4581 <br /> CKM <br /> O. BOX 957 — /� — <br /> --� 351 T40. BE <br /> DI, CA G5241-0957 <br /> LOQ <br /> POTHEAY <br /> 1 /Q` ORDER OF r /��n // OLLARS <br /> ,aye �C/ <br /> ;7 m� T <br /> Q Soot orioai,Cn 152Q <br /> 5m w.w.mm 5,.. 5�- <br /> -- -- - TOTAL DUE S 159.00 <br /> Me <br /> office USE ONLY <br /> . _ <br /> ~rSIICePa W-9... (� Mwy�Illla/1 <br /> $ .....I..L.�.. i........ ......'yw1Mar lMrrwsar <br /> ar.rrrwr...1•r'rwi:wr+.i: �ai1lMYrrsn ea„riaarl,ee111 ane <br /> foo <br /> Awww <br /> AIN <br /> I <br /> w '^� MM�nalllraMMMMaaallaMMeaae <br /> rMeaell$ <br /> _ ...eu 1/10/91) _.------- <br />