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� .,n L.... .. �J�+n►. a-Ic ay a_ Ih k) a51KiLI <br /> UNDERGROUND STORAGE TANK PR06RAN - FEE VAT <br /> FACILITY/SITE NAME FACILITY CONTACT NAME <br /> C NOR-MAC, INE. Don <br /> I <br /> L STREET ADDRESS 6215 Tam O'Shanter SITE PHONE 1 (with Area Code) <br /> 1 (209) 957-9170 <br /> T <br /> Y CITY Stockton, 8T4TE 21P CODE 1 of TANK'S <br /> at Site 1 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P NOR-MAC, INC. Peter Voskes , Operations Manager <br /> L <br /> I MAILING ADD SS APPLICANT PHONE 1 frith Area Code) <br /> C 0. Box 214097 <br /> A916 482-2924 <br /> N CITY STATE TIP CODE TYPE of APPLICATION Tank <br /> T Sacramento, CA 95821 (Closure, Installation, etc.) Removal <br /> A FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> T 1986 1 1981 1 1988 1909 p <br /> I CEI y <br /> E TANK FEE = 150,00 each TANK J <br /> F 1 Tanks X i50,00 1986 1 1987 1988 19NIaLp <br /> A (eultipiy 1-by fee for <br /> C each year applicable) p F NTq( <br /> 141 r� <br /> I STATE SURCHARGE _ $56.00 each TANK (see CA HEALTH I SAFETY CODE Sec 25287 for applicability CE5 <br /> T 1 Tanks X 156,00 1986 1987 1908 1989 <br /> Y (enter iiiiUt and year) <br /> f <br /> 1L PERMANENT CLOSURE (Reeoval or Closure-in-place) <br /> 21CLOSURE FEE = 190.00 each TANK _ 1 iInks-_1__ x $90.00 f 90.00 <br /> c�ecw e Oel.veneO row wvr.er+r <br /> O.ccounrd <br /> RICH -MAR 395 <br /> JIM THORPE. DISTRIBUTOR OF QUALITY PRODUCTS <br /> 368-6175 462-4581 <br /> 351 NO. BECKMAN ROAD, P.O. BOX 357 <br /> LODI. CA 95241-0357 <br /> PAY 19 <br /> TOTAL TO THE <br /> 1 <br /> O�scouHT ORDER O LO / $ <br /> MOV NT OF CHECK \ ' N 0 <br /> D DOLLARS <br /> Bpltko tlN (I/t <br /> LOFFICE <br /> 1H1 W.Walnut <br /> SL,Lodi,G 9530 / <br /> TOTAL DUE <br /> OFFICE OSE ONLY <br /> SWEEPS 1 COMP 1 LOC CODE 01ST CODE AMOUNT DUE I AMOUNT RCVD CHECK�f�CASH RCVD BY DATE RECEIVED PERMIT 1 <br /> n <br />