Laserfiche WebLink
S JOAQU I N LOCAL <br />HEALTH STRICT <br />UNDERGROUND STORAGE TANK PROGRAM - FEE VO EET <br />FFACILITY/SITE NAME <br />A <br />FACILITY CONTACT NAME <br />f <br />L STREET ADDRESS <br />1 <br />SITE PHONE I WITH Ao[A cool <br />Jv.. <br />Y CITY STAT .ZIP CODE t of Tinks <br />� <br />AA APPLICANT/BILLING NAME. <br />it StteCi , _f <br />------ <br />APPLICANT CONTACT NAME <br />L <br />.._..... <br />I MAILING ADDRESS <br />C 0 <br />APPLICANT PHONE 1 "ITN AeIA ca®l <br />p <br />M CIT <br />�, <br />T STAT <br />J) <br />ZIP'CODE TYPE of APPLICATION <br />caa®aafl, <br />G <br />INtTAaaATIONs 1T6. <br />FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR <br />A - <br />G _ .-, <br />total <br />V CRISP TANK TESTING <br />E <br />. 1661 <br />P.O. BOX 30487 931-1828 <br />STOCKTON, CA 95213 <br />F <br />A <br />C PAY <br />! �" rz� 19w <br /> <br />TO THE <br />1 e ORDER OF O a7 <br />Valley Commercitif <br />D L L A R S <br />P.O. Boz 9700 <br />1081 East Waterloo Road <br />C . / Stockton,-uforaIa 96208 <br />D FOR - M <br />U 14 <br />P. <br />E <br />TEMPORARY CLOSURE FEE _ $80.00 each TANK <br />1 Tanks x 180.00 <br />P PLAN CHECK (installation or Repair) <br />L <br />A <br />h PLAN CHECK FEE _ $30.00 each SUBMISSION/RESUCMISSION <br />_ <br />$ <br />REPAIR <br />. <br />R TANK REPAIR FEE _ $110.00 each TANK <br />E 1 <br />Tanks _„ x $110.00 $ <br />PIPING REPAIR/CLOSURE/REMOVAL (tees are per hour, minimum one hour to be paid on plan submittal) <br />R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION <br />(when applicable) <br />SAMPLING INSPECTION <br />(when applicable) <br />(when applicable) <br />FEE _ $30.00/hr FEE _ $35.00/hr <br />FEE _ $35.00/h► $ <br />OFFICE USE ONLY <br />TOTAL DUE $ <br />own <br />SWEEPS i COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD <br />�R�7 �. _' _ -" <br />3 <br />NEC IICASH RCVD DY DATE RECEIVED <br />PERMIT 10.5 <br />poll <br />���� <br />