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SAN JOAGUIN COUNTY PUDLIC HEALYN SERVICE! <br /> UNDEACAOUNDNSTORAGENTANKHPROGRAMI-DIVISION <br /> r ACILItY SITE NAME FACILITY CONTACT NAME <br /> F Eleanor Thomas Steve IJuashnick <br /> A <br /> c - <br /> II FACILITY ADDRESS 303 Louie Ave. SITE PHONE t with AREA CODE <br /> (209)369-2675 <br /> I City1 -.44 swr LIP CODE Mol TANKS <br /> r'x _952.40 et sltE <br /> AMOUNT 12552 <br /> - JIM THORPE, DISRIBU OR OF OUALIIY PRObUbTS <br /> P.O. BOX 357 368-6175 4624581 <br /> 351 N. BECKMAN ROAD <br /> ?U 5-- -- _ - --- - LODI, CA 95241-0357 <br /> d <br /> PAY <br /> TO TH <br /> --- -- ORDER Arai <br /> ro FAL of ,rvvoice• _ - ��� ,y �1 ���J <br /> O L L A R 5 <br /> E,s FARMEAS 8 <br /> TOTAL DEo„C„p„s MERCHA <br /> EN <br /> }pT <br /> LS <br /> n CIUNT OF CHECK BANK FlLipAAPk <br /> C PERMANENT CLOSURE (Removal or Authorlted closure-In-Plea*) TANK I.D. t(s) <br /> L CLD911RE FEE • WAD per hour (3 hour# mIntmus per TANK) R TANk(f)__j _ X 5159.00 <br /> 0 <br /> S <br /> R TEMPORARY CLOSURE (A ane-time permit,, ler revlew/lnapeetIons) TA=D( 1.0. t(s) <br /> E TEMPORARY CLOSURE FEE • 9150.00 tech TANK t TANK(s) X $150.00 f <br /> P1 <br /> PIAN CHECK (InStbtt. Plan 0e0e4 5 Conftruatloe I14epeatians) TANK I.D. I($) <br /> R PLAN CHECK FEE - 553.00 per hour IS hours mtnt” per Faclllty) • 5624.00 minimae f <br /> E RFPAIR FEE (workplan review 5 aonstrUatlen Inspeetlons) TANK I.D. tis) <br /> P TANK REPAIR FEE • 551.00 per hear (3 hour! M1n1mue/tANK) t tANK(e) X 5159.00 ! <br /> A - <br /> R PIPING REPAIR FEE • 553.00 per hour (3 hour minl" per leclUty • $159.00) f <br /> M TRANSFER ►EE • !20.00 UNAUTHORISED RELEASE EVALUATIDN • 553.00/hr f <br /> I <br /> c CONSIILTAIION FEE • 553.00/hr SANPLINO INSPECTION FEE • 553.00/hr f <br /> TOTAL DUE 5 159.00 <br /> 01110E USE ONLY <br /> w <br /> ti <br /> PR �T ol2 (Revlom 1/8/91) Pepe 11 �jr-� 7 <br />