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OQUIN LOCAL <br /> j SAN UNDEND STORAGE TANK PROGRAM HEALTH F E MORS •ICT <br /> EET <br /> `ILITT/SIIE NAME FACILITY CONTACT NAME <br /> Don, s <br /> L STREET ADDRESS SITE PHONE 1 w"" A` coos <br /> T i 3245 N Wilson Way 209 463620 <br /> Y CITY STAT IIP CODE 1 0l Tanks <br /> 3tookton Ca Ca 5205 at Site 1 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P AAA TAnk Removal & Demo' Al Williamson <br /> AAA TANK REMOVAL & DEMOLITION Valley Commercial Bank 14268 <br /> 4900 N. HWY. 99, NO. 206 931-6010 P.O.Box rloo <br /> 1031 EmiP.O.Waterloo Road <br /> STOCKTON, CA 95212 8lnckw.,C.l7ornle 95208 <br /> (�,� <br /> PAYC��9C�/1 f`zfi� — t.: D�CCA S $�O <br /> r T /f1 r I '' <br /> J Gum" "Tin /�Qei�t�l (��J f' CV 2 6-7990 <br /> To ` <br /> THE <br /> ORDER ENVIRON!r>,ugE HEALTH <br /> OF �jP}EIRMIT/S RV1C <br /> 0 CLOSURE FEE 110.00 each TANK ; 1 Tehts_.,(.. 1 130.00 170FpO <br /> S <br /> U . <br /> R TEMPORARY CLOSURE (Only allowed one time lot up to two Tears) <br /> E <br /> TEMPORARY CLOSURE FEE ■ 180.00 each 1ANK 1 Tanks s 180,00 S <br /> P PLAN CHECK (installation or Repair) ' <br /> L <br /> A <br /> M PLAN CHECK FEE m 130.00 each SUBNISSION/RESUMISSION s <br /> REPAIR <br /> R TANK REPAIR FEE m 1110.00 each TANK 1 Tanks 1 1110.00 t <br /> E <br /> P — --- <br /> A PIPING REPAIRICL05URE/REMOVAL (fees are per hour, minimum one hour to be paid on plan submittal) <br /> 1 — <br /> A UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING 111SPECTION <br /> !when applicable) (when applicable) (when applicable) <br /> FEE ; nmo/hrl IFEE a 135.00/hr FEE ■ 135.00/hr t <br /> TOTAL DUE 1 Q ° <br /> OFFICE OS[ OILY <br /> SWEEPS 1 COMP I LOC COOL DIST CODE AMOUNT DUE AMOUNT RCV49 D CHECK 1/CASH RCVO BY DATE RECEIVED PERMIT 1 <br /> T1�V 1 �' <br />