Laserfiche WebLink
N N <br />1- b'lltt Iyv1I y <br />1,%1 }II %1 111 Di I' %R <br />I fif>8 } . f�ami€Iola 1 c..'%Itiktc+Il. C':1 91 ?Il;_t>? p <br />7clenluine: (209) 408-3420 �irr: (2(1,1) f�k-; .; 2 11 > 3491G �Y", <br />FACILITY NAME <br />F CLC +A I"i Y CONTACT NAME ''' J�1 11111J1► <br />FACILITY ADDRESS <br />SITE PHONE #W+TH AREA CODE <br />CITY a ___ _ ___—_.._e _ � � <br />STATE Zip COD'—•'�"`�- <br />IE <br />GA f # OF TANKS AT SfTE <br />APPLICANT BILLINGE _ <br />APPLICANT CONTACT NAME 7 '/ <br />APPLICANT MAILING ADDRESS ' ell, I <br />I APPLICANT Pit7NE # WITH AREA CODE <br />CITY STATE +�- <br />ZIP CODE 1 <br />NE _ <br />CIRCLE WOR({?O BE GONE <br />CONTRACTOR ICC #—` <br />t;iaslrr0 inyldllat --- Re �. <br />ACTIVE FACILITY --- -- r"t` <br />S550 FEE INGI.UL)F"u" F ACILI'FV RE '°=--�-------_ <br />$130 PER TANK AFTER FIRST TANK 'TANK 200J ��i10 20%1 2012 2013 2014 <br />LSS <br />IK P-" LiY ASSEbK SURC`IARE_ KTfm SURCHARGE FUR FACILITIES NC1i ALREADY CAN INVLN'a:JFTY' I <br />cu AT%=gSflDFAC;ELfTV <br />PERMANENT CLOSURE --- <br />IRomoval <br />TANK ICJ #'S9 <br />TEMPORARY CLOSURE ::LL"I U^ FEE = S390, TANK <br />{Mian Rena ,v alIci ire oflorxs) <br /># TANKS x. 53:1.• = <br />TANK ICJ # (g) <br />TE PORARY G'L%)SURE- f -EE z: $3 0 , FACIL<TY s <br />INSTALLATI(?N PLAN CHECK <br />Piana heck ar tl C'onSttuCitorl I eCtsonsf <br />TANK ID <br />t.Atyt tiE n(F W1330FACILITY S <br />REPAlFt PLAN CHECK <br />TANK ID # (S) <br />TANK REI Rt7F IT REPAIR a <br />EE S35C 1 FAC. 11Y �a c1 Icr rnorl to s c} equoyn Sola€Is <br />' <br />et cold <br />AIPING REPAIR FEE rJuTy <br />v , <br />-rfli n <br />MISCELLANEOUS <br />1R45fEREEE S�5 ;. <br />N§gLTATIt N F> F oR <br />t;NAUTH Ri EL RELEASE E' LUA T ION <br />-- <br />__. <br />HOUR <br />_ _._VNMTL_ <br />SAMPLING INSPEC TION F <br />FEES ARE S "3tiC U <br />BASED ON THE $tHOURLY RATE TIME THAT EXCEEDS FEES PAIDWILT, BE 8ILLED TO —APPLICANT <br />TOTAL AMC, UNT D E <br />OFFICE USE ONLY <br />VJ <br />�_..- FACILITYID AMOUNTRECEIVED <br />CHECK* <br />RECEIVED _ DATE <br />H 23 032 (REVISED RECEIVED <br />8.44 1q} — � <br />