Laserfiche WebLink
F FACILITY/SITE NAME y <br /> A Si� I y-X-/1 i FACILITY CONTACT NAME <br /> � <br /> L STREET A RESS SITE PHONE I faith Area.Cade)_ <br />' Y CITY s/d STATE IIP30DE # at TANK'S <br /> I y) J—/ lat Site <br /> -le" <br /> A APPLICANT/BILLING NAMEAPPLICANT CONTACT NAME( <br /> F Jr,v, :e.. <br /> F -1�f:f.� <br /> L <br /> I MAILING ADDRESS <br /> C APPLICANT PHONE # (yith Area Code) <br /> A 1 <br /> N CITY j' c ri! STATE IIP CODE TYPE of APPLICATION <br /> T 95,t r (Closure, Installation, etc.) 6A;S 6'=c t <br /> FACILITY FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A <br /> C 1986 1987 1988 1989 <br /> T <br /> V $ <br /> E TANK FEE _ $50.00 each TANK <br /> F I Tanks x $50.00 1986 1987 1988 198P NT <br /> A (eultipTjr_I-by fee for <br /> C each year applicable) F S <br /> IAN P <br /> L STATE SURCHARGE _ $55.00 each TANK, (see CA HEALTH b SAFETY CODE Set 25287 for applicablillftypdj <br /> I <br /> T # Tanks x $55.04 1386 1981 1988 ��N ENjq <br /> Y (enter eaount and year) ERVlCES $ <br /> C PERMANENT CLOSURE (Removal or Closure-in-place) <br /> L <br /> 0 CLOSURE FEE = $90.00 each TANK <br /> S # Tanks '_� x $90.O0 $ /k C,`� <br /> - DATE INVOiCE AMOUNT 96-108 <br /> WESTERN METER SERVICE, INC. 1211 <br /> 2735 TEEPEE DR. SUITE E <br /> I STOCKTON,CA 95265 9452 <br /> 12091948-6124 <br /> cam, <br /> PAY 41l4fLLARS <br /> DATE - TO THE ORDER OF OT7iER ROSS Tki 0U ACCT5.PAYABLE DISCOUNT CHECK AMOUNT <br /> 1 <br /> WE TERN MET SERVICE, INC. <br /> UNION SAFE DEPOSIT BANK v <br /> STOCKTON,CALIFORNIA <br /> I i <br /> 11'0094 5 211' is I: 2 2A ° SOL 2 S458u'O6 I <br /> v <br /> vrrtLc uac Uacr <br /> SWEEPS # COMP # LOC COEBISTCDOE AMOUNT DUE AMOUNT RCVD CHE /CASH RCVD BY DATE RECEIVED PERMIT Ila�S �y�r-� 9 1 r� /�a �'�sa- r 7 �� <br /> Itr <br />