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' EaAN JOAQU I N l_dCAL. WEALTH V I S•TR I c r
<br /> UNOERSPOlUND STORAGE TA..)1K PR06&Ah FEE HURKSNEEi
<br /> l . . FA,(LITY CVINTA(�T IIAME J
<br /> • `rlFaclLltYlsiTE NAME
<br /> C -'J��V� Sf?IZ�/tGE:- �o►- .__ __I.,]I L t.,L4 M.
<br /> $ITE PHONE � utTH•earA Ca�i�lli I J 1��
<br /> L STREET ADDRESS
<br /> ' 1..4r.:._3 � 1 i.d.. � LDU .�,_�... _..._.. __.�_._.... CZtJ�1��3�-• 3(d7 .
<br /> !__......1. :._.T_ -.---•--•- :NV4Z NMENTALHEALTI
<br /> Y CITY STATE ^ t[P Ctl9£ E of Tanks PERMIT/SER/I F
<br /> L. of (64J�_rJ_.Zd a; S1to _--.,___._... .._
<br /> P APPl1CANTIflltL1NG NAME.__ IAPPLICAIIT CONTACT NAME
<br /> ' P , I�, LGE �•:d-?sc�� ... .,..:_ __-__ __--_...._-------.�_�....:.._._._.
<br /> L._.___ _:...-.—. -- - A PLICANT PHONE I "TH ARRA Cuoa
<br /> [ TfktllN^v ADDRESS I 9w5
<br /> t A iIP'C00E YPE Qf APPLICATION
<br /> 1 city Sp. q;�LoaVKK+ 1H717ni L�T�arc,_crrr,�pt....s,!�A61
<br /> '
<br /> FACILITY f EE = S10h 00pach SIT£ ADDRESS per YEAR _ _ _ _..._.._. TOTAL- - --
<br /> A .,_........_.,_..._... ._....: ..r--W.....- -+•---....198b..1...1...'... ►�---- .._.19RR_ __._[989 ___...,,-. ._._-.�..
<br /> E tAlTk rEE W.00 tacit TA)1t:
<br /> IF I tanks X S$b,COW 130fi�_
<br /> A TfachuItyut Abr fee (or
<br /> C each year aoD!f c abl e)
<br /> L STATE SURCHARGE - 156,00 ei(h TANY (SQA- CA~NCAM. t• VFUY Cn[Is 54( 25281 !O.T' 00Iic4b)lity) _•_ _
<br /> tI-Tasks ........z_t 6 r,0 1986 '-- ........1907 'I- --1598
<br /> Y (enter ieount and yw)
<br /> t'TPEPMANENt-CLOSURE (4104 'Or 023501.0-01•VPI.AM)
<br /> .._r...._.... ........_..
<br /> 0 CLOSURE FEE e 190.60 84th TANK tants - x f94r.CC _ - __.ys -.__.. ..---•_- -
<br /> E TEOV-PAM(LOEUFE Uloly"allordtd�oneYti.Sv_for uo_to tyr. .ears!
<br /> E TEn>,GRt~P,Y CLGSU°E FM
<br /> IP
<br /> trach TANK i I Tanks _ r.a I9�'•.r�,.. -- .-..---- !__,-_ -
<br /> IFIPCAII CNEo, (Installation or P.opair) _..._•.__..... .. _.... _._-. - - -...._ -......- --.... --' - _•_.. �-
<br /> ` +rrl..
<br /> 11PLAN CNICK FEE,. .__._
<br /> �, REPAIR
<br /> '...-----.._....... ..�..__ . -.---......�, ! Tants--�- - X
<br /> l TA.W REPAIR ,EE = til10.00 ea.( iA.N): ---- ��.
<br /> fEI ..__..^....... ..•. ....� .."•__.. .Q,-r _�.A..-6'...�'',l,r.. RIL A v_ or, pii SUti4ltt8l)
<br /> �,+�PIF11T.+ f;EPhlRrt:lO��J�E!REISrJ.AI.lf,.� z :•..�:�.....'.'. ,'...._... . ..---- --'-- -.....-----••-_.__._._ •__---_._____
<br /> 7 "dll4
<br /> iHOsll `? ' EAS
<br /> : f' 'tVA;UATiJti^ !!
<br /> �(( iJtilJ'.: ISPii(.'tnn
<br /> ' , ! (vlttn il:dti, iv�cn pllcable'I
<br /> I;vIS4n dpp+l(3h:e1 I ._dv' .... . .. .. . .. _ .._. -----.. .., .-•- -- --...__ ...--•------ -......._-.._.
<br /> I l�EE = f30,i!)!Jsrl -
<br /> FEE
<br /> .L'.
<br /> ......_.. ... C i I
<br /> _... _.. .. TOTAL DUE
<br /> My r
<br /> rr^. n rva r,i•� -.,_�' 1 ..,.I •n'rr k I�!( f r'7 rG'•:C•..., 1r••.r 1+ r dF�•t + .'m,•�rv•..r•
<br /> rp. vl. ! , p� +� ;� 'y{, ,j1 I' r. �j-.l�tr+r,..r,.Tcl'•:;i L�I'+t: �'11i,+y. "i�d! �!I'u-AT�'1
<br /> 44OUr ,tfl;i,r�,al PY�:r-r��:!i4at�'a.'��
<br /> �j6 i'n��'-(d!�N:!i� •(ur��,,l��j�j'1`�s����N,q�r.:f .,r,!5�11��!.i��&4'.iSua�G�'i�.r..iL��.:r . .'_-r!' .r�.. _t'1� �,.•;. k: +, d.:,W�' '
<br /> COMP I LOC inn; DIST COU. {1 riU, hrs.tl1r ;vD CHr" p!CASN RrVO DATE P.i:C MED PEM'. I
<br /> I :. EPS...I
<br /> .00
<br /> I� � ��.••�•L. .l.[-1- .. . +, i ''1 TM + OFA-�i�li'r�tl,... r, T I.Ri Til �i.!R + I�-r..r •f•,;'.•'�
<br /> i•L., . .., ,,. t> ..• rsc4+l:+•. -nc�taci:'+isr,-I". �.Ir.tr"CP:' .� .1.,1 t,? .'i�6 u1L',�liluli�i:�!h:III •r��..r�:r,..�le{irTr;cT{I�,�i�i�irralt! . .�„ !1 .i/I�:,,ai;p••,ji
<br />
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