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AN JOAUUIN LOCAL <br /> / B <br /> UNDERGROUND STORAGES TANK PROGRAM A LF R i G T <br /> FEE WORI�T — <br /> F FACILIIYISITE NAME FACILITY CONTACT HANE <br /> A Brett L. Winquest Brett L. Winquest <br /> C <br /> ISITE PHONE 1 (with Area Code) <br /> L STREET ADDRESS 4627 E. Plain Street <br /> I <br /> 1 <br /> Y CITY Stockton„ STATE ZIP CODE 1 of TANK'S <br /> C1 95205 at Site 1 <br /> A APPLICANTIBILLING NAME APPLICANT CONTACT NAME <br /> PP Same Richard Thorpe <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE 1 (with Area Code) <br /> C. 209 941-4527 <br /> N CITY STATE ZIP CODE TYPE of APPLICATION Tank Removal <br /> r (Closure) Inslallallon, etc.) <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> A <br /> C 1986 1987 1988 1989 <br /> r f <br /> 1 _ <br /> E TANK FEE = 150.00 each TANK <br /> F 1 Tanks _�_ a 150.00 1986 1987 1988 1903 ��j n <br /> A (multiply by lee for o v <br /> C each year applicable) 5C) 1 Jr n <br /> I <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH I SAFETY CODE Sec 25287 for applicability) <br /> I <br /> 1 1 Tanks____ s 156.00 1986 1987 1900 1989 /9'/0 <br /> Y (enter iii0unt and year) <br /> C PERMANENT CLOSURE (Resoval or Closure-in lace) <br /> L f 90.00 <br /> a ; <br /> S ° BRETT L. WINQUEST 3-37 2055 <br /> U MARY FRANCES WINQUEST 1®�p <br /> ELIC. C3322359 N5750310 <br /> 52 - flH4R10RE ST 208-941-45 �) Ig 90-1030/12 f <br /> T ON, CA 200 J 3211 <br /> PAY TO EWy <br /> P OHOEfl11 <br /> _ 7 <br /> N 'SaCIiU1IC11tQ ,� ' <br /> MARCH LANE OFFICE <br /> R 3 1407�rIAer h Lene tgykton,CA 85207 <br /> E MEMO`` 11 1 <br /> P <br /> A <br /> 1 , <br /> R <br /> (when applicable) INSPECTION INSPECTION <br /> FEE = 130.00/hr FEE = 1135.00/hr FEE = 135.0O/hr 1 o G .r v <br /> TOTAL DUE 1 90.00 <br /> OFFICE USE oR(Y 2 T— Qv <br /> SNEEPS 1 COMP t LOC CODE DIST CODE I AMOUNT DUE AIIDUIII RCVD CHECK I/CASH RCVD BY DATE RECEIVED PERMIT 1 <br /> Utti 1�D 2oS� eff <br />