Laserfiche WebLink
SAN OAQUIN LOCAL HEALTH DI <br /> RICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE NORKSHEEi <br /> F FACILITY/SIZE NAME <br /> A FACILITY CONTACT NAME <br /> I - " —-- -__ e_e CIOI lS"�. CO. �,3c• FJP-tZI l I z !i.[ <br /> L STREET ADDRESS a''-' -- _ <br /> ! r <br /> SITE PROYE 1 WITH AREA <br /> coot <br /> Vo Lel._�:�---- <br /> Y CITY — <br /> $1ATE IIP CDOE�a of Tanks <br /> _ _....__.._. G NAME .__ __.___ C'3� 5 _ at Site --- _ <br /> A APPLICANT/BILLING NAME <br /> F ` APPLICANT CONTACT NAME —' <br /> I MAILING ADDRESS --•-- _ <br /> C APPLICANT PHONE 1 <br /> WITH ARCA COD! -_ <br /> A CITY ___.....__. ---- --...--••--.— <br /> N CITY - _ <br /> STATE TIP'CODE TYPE of APPLICATION <br /> T CLOOURE, INlTALLATION, LTC. <br /> FACILITY FEE = 1100,00 each SITE ADDRESS per YEAP, — — <br /> I 1986 1987 - — 1988 1983 TOTAL <br /> _._ <br /> T .. <br /> E TANK FEE = 150,00 each TANK ----- —__— f — <br /> F t Tanks _ z 150,00 1986 1381 <br /> A (Rultipry_( by fee for 1988 <br /> C each year applicable) 1�AY ENT <br /> 1Z.` I'VE D f <br /> L STATE SURCHARGE = 156,00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25281 for <br /> _ <br /> 1 tTanks z 138 <br /> 156.00 1986 _ — <br /> 1987 8 - -- <br /> Y (enter ii6unt and year) _..—•—_-,--.-_,_„—_— -- 1383 <br /> -NSP RMLI�JDtKVLCZc�IT <br /> IC PERMANENT CLOSURE Renova-or Closure-in-place) <br /> L <br /> n rl OSURE EEE_ _f3 - - _ <br /> O.Oo Rash TANK _. 1 tanks z 190,00 <br /> THIS CHFCN IS IN'gVMENT OF THF 1.U.WINC _ _--• <br /> WELDON, WELDON & COWELL CONTRACTING )t <br /> HICKMANX 69 <br /> ,CAUFDpNIA 95323 _ F <br /> FAX%8181743723 --- 1492 <br /> --.— <br /> CENTRAL <br /> 5386 CA 9 —__ -- <br /> PAY THE til(� WATERFORD,(JI►f 90.2067/1231 <br /> TO THE �---DOLLARS =--_---- i <br /> ORDER OF ` , DATE CHEOK O. AMOUNT _ <br /> OVER $500.00 2 SIGNATURES REQUIRED •------.._ _ 6 <br /> 11.00 149 2118 t; i 2 i 1 206 781; 0 30 20 2 4 1 3811' AUTHORIZED SIGNATURE <br /> OFFICE USE ON(y MAL UUc <br /> Ij�N�m��fl�!�!fl� I�I!I!I�P91 �pp�pi19991i1��i117� I�P�fl!&�118ii!111�III�c��iQG!11i�m�1�1@�Ii;1I��pQpg1111�4Nlnll�'i�IN�i�l4�'�I�P�I�I@I&II�FR11iNl�la !Inll�lllllt�l°ifiililihl filun�i�29�ICG <br /> SAEEP5 1 COBF t LOC CODE DISI CODE AMOUFIT DUE AMOUNT RfVO CHECK-1/CASH RCVD RECEIVED DY DATE �IV�ED� <br /> 9 <br /> PERMIT t <br /> T' "1 �' � '�r�.l �.,��II�nII�flI�!�'M� I���n�l�� nl�p�I��llln!�4!II.�!II��I!II;rI�Im!n��1�181Qllll nr19�G9hfi�fIIII��II�II� I�� pp�911 I�IMB�hII�B�I�I�!�IIIIQP!Il .nll�l��� � .. �p�l:, <br />