Laserfiche WebLink
fSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> --- ;N <br /> ----.... <br /> YISITE NAME r FACILITY CONTACT NAME n <br /> ADDRESS � SITE PHONE I WITH AREA COOK G <br /> STATE LIP CODE 1 of Tanks <br /> at Site <br /> HUBILLING NAME APPLICANT CONTACT NAME <br /> ADDRESS APPLICANT PHONE 1 WITH AREA CORK <br /> 2013 — �S7 = z2G� -- - <br /> T — — STATE IIP CODE TY PPLICATIDN <br /> SURE, INSTALLATION, ETC. <br />[7Ez <br /> $100.00 each SITE ADDRESS per YEAR _ TOTAL <br /> 1986 _ — 1987 �O9U �✓ /OjBU � f 2-0 CJ — <br /> 0.00 each TANK fee for --licable) U <br /> SURCHARGE = $56.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25281 for applicability) <br /> — x (56,00 198866 , 7I}�—J1981 1988 1989 <br />[NT <br /> ount and year)—_ l^—l_.._ _✓ ---•CLOSURE (Reooval or Closure-in-place) <br /> FE — i90 - --_ ----_- -.1-Tanks__)-_ x 190.00 S y <br /> OELIV M <br /> ILID_WINL ACCOUNT�S) - <br /> SAWMAKER, INC. 679 <br /> 16177 SOUTH MC KINLEY AVE. 983-0606 <br /> LATHROP. CA 95330 <br /> Q 90.3298 <br /> CES <br /> 1211 <br /> uNT <br /> PAY TO THEW. <br /> ORDER OF A2iJml L c4:4L- /-/ 1_ Ti/ $ <br /> Ns — <br /> L�� <br /> Ecn /LL! DOLLARS <br /> lahalioual 611 North Main Sum I <br /> a)E/t hlanlea'a, California 95336 <br /> TOTAL DUE <br /> USE ONLY <br /> VV9N 89VN99C� '11Q94fV�1��V91� _.. ... II• d� 1 rr L -. _ - - _.-7- —t <br /> _...-COMP_ LOC CODE OIS ODE AMD4���. AMOUNTRCVD CHECK <br /> L/CASH I RCu <br /> VBY n ATE R� D@EUV��IN�IT 1��l�q� <br /> "III I' IIT 11111111 '11111 I. ! u'1' 'i P cuu amr: a omn imr' ,il !iiia <br />