Laserfiche WebLink
S JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDEIND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> IL[TY SITE NAME FACILITY CONTACT NAME <br /> FACItITY ADDRESS SITE PHONE with AREA CODE <br /> I -- STATE 21P CODE at of TANKS <br /> T CITY ,, ¢- r� <br /> Y at SITE -- ( �= r�L!✓`i� <br /> A APPLICANT/TlILLING NAME APPLICANT CONTACT NAME <br /> P ` <br /> •G C �1� _ —L d I <br /> t APPLIC HT PHONE R 111TH AREA CODE <br /> I MA�LiNG AOr�SS <br /> A <br /> STATE IIP CODE TYPE of APPLICAIIOH <br /> ^ CLOSURE, INS N CITY IALLATION, etc. ilk <br /> A - BANK OF STOCKTON 90-103 <br /> C <br /> OM...ERCIAL SAVIN-9 TRUST 1 21 1 <br /> C STOCKTON.CALIFORNIA <br /> r 1 <br /> 29298 <br /> V CALIFORNIA CONTRACTOR LICENSE 309[09 C-51,SA <br /> — <br /> 008-820 N.UNION 9T.,STOCKTON,CALIF. 85265 <br /> E I P.O. BOX 508 STOCKTON,CALIF. 9520'-0508 <br /> PF40NE;091444-8335 <br /> A <br /> I -- <br /> PAY 700 .ARS <br /> t e BATE CHECK N.O. • <br /> OOLLARs CENTS <br /> r °° <br /> To THE �O/-/r� f /\�`}\ {�R 1\ r <br /> Y ( ORDER OF- 5�1h_,'.. ,�VLfi-'�-=-�.�� �2a.._.�5.�-� - <br /> STOCKTON SERVICE STATION EQUIP,CO.,INC.! <br /> R <br /> D <br /> U T <br /> R _ <br /> JAPLANCHECK (ImtnI(.Plan Review !l ConstrUCtiOn inspections) TANK I.D. #W PLAN CHECK FEF553.00 per hour (I3 hours minimum per Facility) !424.00 minimum s �� <br /> R REPAIR FEE (wnrkplmn review R construction inspections) TANK I.D. fl(3) <br /> P TANK REPAIR FEE - 553.00 per hour (3 hours minim WTANK) 0 TANK(s) % !154.40 = S w'v <br /> A ------- — ti- <br /> R PIPING RFPAIR FF.F = S53.00 per hour (3 hour minimus per facility = 5154.00) <br /> M CON;ULTATMIS T UNAUTHORIZED RELEASE EVALUATION SAMPLING INSPECTION <br /> I <br /> C FEE = 1 �- ihr FEE - E53.00/hr FEE ! ! 53.00/hr <br /> - -- -- - - TOTAL DUE _ 77 <br /> OFFICE USE OW-Y <br /> �::.» .aioar "i:»rMeisiav»xoiW. 'iieieuer»::ioaoi»wwiaieiia:id»»m:iii:MwMww>;iiilww,Tiinwi9tiM7iiiiirwiw <br /> liit.wwrs»uiwiiliwitiiieiliwwlii+li+iiiiiiliiii:iiiwwiiiiwiiiloiiiii+iiiiaieei�°'~ <br /> `d `"""Iff TM'"'b�1t`�"il`�'m <br /> 64+aa.qN»I+Y MM W1lIM!MR{%'d ffW11F KY WAee MN Ff1.:dF WA ••M»•F MIOMB».119lMM»IN�11»7»I»IMFIIIMF II»IMNB11»MIME7M�11F►11»»UIFw»l MIlMM1�aM1FR 1»FM 1M�1111»M» 7MF <br /> a.s gas zv.a u�. .xikx:'r av.x YaI ax5.t>�F'.s wx�etlt:z4-zt>zx;nx yaxx Y.SI R�RLXS RY,3 Roux xd kaL•f l93i SRxlMlltx 91M 11MMx SMxIYIAMF fAl{lIYM RIM RRx11U111are IYWSFARIi SIIIAI530A1 itY1i SMFK flMl ilRxr SRx 11151IIlx�I llhLl11p1t 9?-x�Fx xar xxi <br /> FH 23 032 rRFII 1/101911 Ft Pace 11 <br />