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.r.a. J . "6JAN i-UGAI- HEALYH DISTUCT <br /> UND UND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> -- <br /> .'IL1.TY/SITE WE FACILITY CONTACT NAME <br /> ` C Knapp Ford Jerry Knapp <br />/ 1YI TN M[A CON <br /> rTkE:E:T�AAORESS555 N. Main Street SITE208f 139-35611YY Mantecai T 95336CODE I ofiTanks te two <br /> A APPLICANTIBILLIN6 NAME APPLICANT CONTACT NAME <br /> P Precision Industries, Inc. Nick I3okides <br /> L — -- <br /> I IIAILIN6 ADDRESS APPLICANT PHONE 1 10111N A09A cN[ <br /> C 1041 S. Pershin Avenue <br /> A - <br /> N CITY STAT TIP CODE TYPE of APPLICAlION <br /> T Stockton CA 95206 cLo[w., <br /> FACILITY FEE • $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A — <br /> T 1986 1987 INS 1989 <br /> I $ <br /> V <br /> E TANK FEE • $50.00 each TANK <br /> F 1 Talks 1 150.00 1986 1981 1988 1989 <br /> A (Nltiply-1-by fee for <br /> C each year applicable) $ <br /> L STATE aURCHARGE _ $56.00 each TANK (see CA HEALTH A SAFETY CODE Sec 25287 for applicability) <br /> I <br /> I 1 Tanks$____ 1 156.00 1986 1907 1988 1983 <br /> Y (eater aeo9nt and year) — <br /> 1 <br /> CALIFOgN1AxFIRST BANK 30.00 <br /> RECISION INDUSTRIES, INC. '°""`•'AALI .00 TBANK =A ...M <br /> 1041 S-PERSHING AVE. <br /> <br /> (209)452-9911 - <br /> 4222 <br /> DOLLA <br /> TTO TMs . l y `.'. <br /> :ORONR OR L I Ong •omw. an=on.• •TwTx <br /> AMOUNT •x=Ux,T TAX TxA •.o.L <br /> ANS© u( k <br /> PREC N I S' ll i <br /> �o <br /> IIf LL � •yv,vv..( <br /> 1 _ <br /> TOTAL DUE 1 <br /> 90.00 <br /> IiFICE ISE Illy <br /> SWEEPS 1 COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK 1/CASH RCVD BY DATE RECEIVED PERMIT 1 <br />