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— <br /> TME K RICH-MART 10663 <br /> JIM THORPE, DISTRIBUTOR OF QUALITY PRODUCTS <br /> _ 368-6175 462-0581 <br /> 351 NO. BECKMAN ROAD, P.O. BOX 357 <br /> LODI, CA 95241-0357 ^ WiO,i/1211 <br /> PAY -�dC/LL 19 V <br /> TOTAL TOTHE <br /> ORDER O wi $ <br /> OF <br /> olecouNr <br /> AMOUNT OF CHECK <br /> Bank -. ._ -- --- - !/MOS DOLLARS <br /> r <br /> IOOI OFFICE <br /> TSG W.W.I..'k,b I' <br /> AFACILITY TEE = 1!00.00 each SITE ADDRESS per YEAR TOTAL <br /> — <br /> C 1986 1907P <br /> 88 1989 <br /> 1 <br /> I <br /> v EGD t �� v <br /> L TANK FEE - $50.00 each TANK <br /> f 1 Tanks a 150.00 1906 1987 1988 1989 <br /> A Uultiply 1-by lee for <br /> C each year applicable) <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH L SAFETY CODE Ser 25287 for applicability) <br /> I <br /> T 1 Tanks : 156.00 1906 1907 19BB 1909 <br /> Y lenter iii, and year) <br /> FPERNANINT CLOSURE (Resoval or Closure-in-place) <br /> = 190.00 each TANK1 Tanks r 190.00LOSURE (Only allowed one time for up to two years) <br /> LOSURE FEE = $00.00 each TANK ants r 180.00 S <br /> P PLAN CHECK (Installation or Repair) RECEIVED <br /> L <br /> H PLAN CHECK FEE = $30.00 each SUBMISSION NAR , IN COUNTY $ <br /> 0'*' *7 <br /> ENVIRONMENTAL H <br /> R FEE = 1110.00 each TANK 1 Tanks : 11(0.00AIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> ED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> icable) (when applicable) (when applicable) <br /> 00/hr FEE _ $35.00lhr FEE = 135,00/hr <br /> i <br /> TOTAL QUE 1 S <br /> OFrFCC USE ONLY <br /> I •I 11 I� I� I Ali <br /> SWEEPS 1 COMP I LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVQ CCK /CASH RCVQ DY DATE RCCEIVED P[RMIT 1 <br /> J-.!1pMAll <br /> �N�O�II I, 1 " ' p�l0lililpONl!IVIIIAtlII �Iml r' � 'i ill o <br /> 1 0 7-1f � -__��___i.��IIV11"II"pipl9l(LI IPICIVGJI�IfICIICIIIIVVIVIIVP� ' i mi i I ��i it I i I(� I N Illi I .I <br />