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�F FACILITY/SITE NAME <br /> c r L) �? . <br /> L STREET ADDRESS SITE PHONE 1 WITH 1149A cunc <br /> Y CITY STATE ZIP CODE1 of Tanks <br /> at 5i to <br /> _.. __.. r e..�'----.---_-----•- <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P , <br /> L <br /> 1 MAILING ADDRESS AP� CANT PHONE 1 MIT" AREA caoE <br /> A _ -_ <br /> N CITY , STATE TIP CODE of APPLICATION <br /> of <br /> INOTALLATIOH, •ETC.to <br /> -• <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A ....._._ � ._�_ _ �. .. .__. 1986 — 1937 l48$ 14Q9....._....._....._ __—_._..._ <br /> .-.. _.. ----._.......___.._..,_._ _.__.._.__.._... P Y 'Jl i iii.t <br /> £ TANK FEE 150.00 each TANK <br /> F I Tanks _ x 150,00 1986 1487 1988 )48'3 T_ <br /> A feultipiy"l'by fee for --- �.____ --- 1{iT �ICEti <br /> C each year applicable) _ _ <br /> I <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH L SAFETY CODE Sec 25287 for applicability) <br /> T I Tanks z 156,00 1986 1487 1988 1909 <br /> Y (enter mount and year( <br /> 1 <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> O CLOSUR <br /> 5 a 140 00 eac — _—' 1 Tanks_ z 190.00 ��— 70 <br /> - - �� .� - - # -- �---- <br /> R - <br /> Ell <br /> CRISP TANK TESTING 1602 <br /> P.O. BOX 30487 831-1828 <br /> STOCKTON, CA 05213 80-9907/1211 <br /> P ' — <br /> L <br /> APAY <br /> (l TO THE — ' H / <br /> ORDEROF �' �U� fl1 ��� I L �! I ✓r <br /> / <br /> Q [J lkl Y e 5('� --,e -__ DOLLARS <br /> R Valley Comm mial Bank / <br /> E East Box Waterloo <br /> Watnrl <br /> lOSl East 4Yoa(toad <br /> A ��yy Stockton,California U5208 <br /> I <br /> FOR 4�h-( c �°PS <br /> TOTAL DUE <br /> OFFICE off ONLY <br /> 195 �� f I9�II�J f ��n �I V��1 119 i 9 I iIOD I !<I V 11 li d" V IMI 4C V91VI��1!�J I U y�'f�CUI �L� dV�il�! !Ji llilV�� 1!I411111 N�tlQ!!��I�II�III�y: ' 'JG�G� <br /> . _. _.....__.. _ SN <br /> SWEEPS 1_. COMP.I_ LOC CODE DIST _ _._.._ <br /> CODE AMOUNT AnauHr RCVD VD BY DATE RECEIVED PERMIT 1 <br /> NE�©�ARC-._T_-_.. <br /> 23�b �oEi� O/ 3,2 <br /> X71 <br /> IT P119611611,14 <br /> qSI I li,l' I I�ll4II41V&I i Pi' !l U4ff4'� V�11�C�J31 J?VI�G�J fG'�J4R i 1141 ,til 14 iG�141�1n14f 41 WVI I�'Il!Jil9ul EI�VNI4 IIIpfllliVul�'1191A044.III�jaIi�JaII011111111V <br /> 7 EV �6 + ��� <br />