Laserfiche WebLink
SM JOAQUIN AtTY PUBLIC HEALTH SERVICES-ENVIRONMEW HEALTH DIVISION <br />UNDERGROUND <br />STORAGE PROGRAM <br />w WORKSHEET <br />FACILITY NAME FACILITY CONTACT NAME <br />Norms 76 Dale Heinze <br />FACILffY A06RESI 817E PHONE # WITH AREA COD <br />633 E. Victor Rd. (209)367-1796 <br />CITY <br />STATE ZIP CODE <br /># OF TANKS AT SITE <br />Lodi <br />CA 95240 <br />3 <br />APPLICANT 91LUN6 NAME <br />APPLICANT CONTACT NAME <br />Oil E ui m n <br /># TANKS X $387 = <br />APPLICANT MAILING ADDRESs <br />APPLICANT PHONE # Wml AMA CODE <br />P.O. Box 950 <br />209 754-1808 <br />CRY <br />STATE <br />I ZI CODE <br />CIRCLE WORK TO BE DONE: <br />Closure Installadw Retrofit <br />San Andreas <br />CA <br />95249 <br />PERMANENT CLOSURE <br />(Remov#1 or Permitted Closure in Place <br />TANK ID #(s):URE <br />FEE =5287 /TA <br />CLOSNK <br /># TANKS X $387 = <br />TEMPORARY CLOSURE <br />Plan Review and 1 <br />TANK ID # is): TEMPORARY CLOSURE FEE = $267 / FACILITY <br />�m <br />REPAIR PLAN CHEM <br />TANK ID # (§): <br />TANK LINING REPAIR FEE = $267 / TANK <br /># TANKS X 1267 = <br />TANK RETROFIT REPAIR FEE = 7 / FACILITY <br />$ 267.00 <br />PIPING REPAIR FEE = 267 / FACILITY <br />MUELLARIOUFS <br />TRANSFER FEE = $ 20 <br />CONSULTATION FEE = 5 89/ HOUR <br />UNAUTHORIZED RELEASE EVALUATION FEE = 89 / HOUR <br />$ <br />SAMPLING INSPECTION FEE _ $ W HOUR <br />� 1t#ti;�,+..y 1•�-�c�Lw�i�?.'i1i1"�a'li[�'��"��1■"�ll"�'ll'd'�'I:I�V��{�a�wpr'+a n.r� v+Y3a1■7_i;�_al.����fvn�rru�,.,il <br />