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FILE ACTIN 1111 UCT10NS <br /> -WIT til <br /> DATE.,��3.Li J <br /> cG_e uwrt ry -_ <br /> Faa+, <br /> FILE TYPEt WEL CCLDRt : HEALTH SERVICES <br /> 'H DIVISION <br /> RAM - FEE WORKSHEET <br /> UJARDOJS W41E (:EVERAYOR 'ALW)N WBu rK STRIPE Top 7FACILITY CONTACT NAME <br /> S TDNS/TEAR <br /> vjjADWS UASTE GEVERATOR HITf WCaARGE STRIPE TOP 5 1DVS/YEAR TE PHONE # with AREA CCOE <br /> V,URDWS VASTE FACILITIES HITE R/YELLCU {ORDER # of TANKSIsq= Pervit/V►rl►rcl - at SITE / <br /> cl APPLICANT CONTACT NAME <br /> 1A71,ADOUS UASTE SITESt HIIE WRED BORDER <br /> A"MCUED <br /> ST FACILITIES IGHT ELLE WBLACK STRIPE Top APPLICANT PHONE # WITH-AREA CODE <br /> P CODE TYPE of APPLICATION <br /> T CLEAN UP SITE HIYE WPURPLE {ORDER CLOSURE, INSTALLATION, etc. <br /> TOTAL <br /> T PILoT PROGRAM SITE HIIE WLIGHT RLUE STRIP Top 1986 1987 1988 1989 1990 <br /> Oo IDS icy <br /> UWE SITE MITIGATION HITS WGREEN BORDER 5170/TANK (after January 1, 1991) <br /> HS•TS.I,O/R(AW <br /> 1991 1992 1993 1994 1995 1996 <br /> VVIA011. ASSESSMENT HI7E R/RAMM BORDER <br /> e lX)YTANI WTIC61 ` D 5 ^) <br /> Lifornia H 8 S Code, Section 25287 <br /> ABEL IVf0MTICW TART VEU FILE TART ADDIT IDVAL f1LE <br /> 1991 through 1996 <br /> TREET ADDRESS �� D� S f,Y <br /> ITT ILE Of__ <br /> TANK I.D. #(s) <br /> AGILITY VANE # TANK(s)_ X $159.00 = S <br /> TANK I.D. #(s) <br /> ETURV T0: LAC T0: LAG DATE-__/_—J— <br /> Y TANK(s) _ X $150.00 = 5 <br /> IrILE In FILE TYPE nottd Bbovt if SPECIAL IVSTRUCTIOVS <br /> 'ANK I.D. #(S) <br /> AIL TO RESt VOTED ABOVE ILIVG ADDRESS Bf IOr <br /> 8424.00 mini mum S <br /> 1 <br /> ANK I.D. #(s) <br /> . TANK(s) X $159.00 = S <br /> ILIVG ADDRESS <br /> nun per faciLity = $159.00) S <br /> �ITf TATE IP <br /> SAMPLING INSPECTION <br /> PECIAL {NST 10114t <br /> �Y 7 FEE = S 53.00/hr <br /> 1 l <br /> TOTAL DUE 5 3 <br /> t9 DDS(Iv)Ve9 (Cf�Y Gb9G C Gf2 ��uy « ; �. E. ..............! <br /> 'k�L�IP%E�'�'�ck1�I;I�s,xw <br /> l VQ�rI /4� 5 ... '. <br /> g.......... ). L........................1........................1..................................1.............................. ....... <br /> ........... . <br /> focv 17/2A/90) ft Pa or 11 - <br />