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v UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> F FACILITY/SITE NAME FACILITY CONTACT NAME <br /> A <br /> L +3" SCo Ski <br /> I ! <br /> LSTREET ADDRESS ��^�, SITE PHONE I With Area Code; <br /> T (JV I POS A <br /> Y CITY I STATE 11P CODE k of TANK'S <br /> OCICtO� at Site <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> tNClfY <br /> NAILINGAPPLICANT PHONE I (with Area Code) <br /> STATE 71P CODE TYPE of APPLICATION <br /> (Closure, Installation, etc.) <br /> F FEE = $100.00 each SITE ADDRESS per YEAR TOTAL <br /> A <br /> C <br /> r 1986 1581 1988 19813 <br /> 1 <br /> V t <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> CAL,oIA.ORoI! FIRST=BkA. <br /> No,KPRECISION INDUSTRIES, GGYGR. .. <br /> a 1041 S. PERSHINGAVE• 90-49 <br /> STOCKTON,CALIFORNIA 95206 1199 <br /> (209)462-9911 3273 <br /> AY `I't(,f rV t� 2 d lJ N I YL Tom/ <br /> 41^^'Cf p DOLLARS <br /> ,'�,�.�� Yrl••'.....�(1` �'y.plw"rl��,rRl•.r: ifT �11ri [IT(•��.RGY IL �XT4Ri �'I,X� If <br /> T?...�:, <br /> l fl4+Rv t <br /> II i . r <br /> Iq 7c)P% <br /> arc P(zysn /J <br /> ,. PREC IN INC <br /> 1110 <br /> .LC.- <br /> I <br /> SWEEPS 1 COMP I LOC CODE DIST CODE ANOUNTbUE 'AMOUMT-RCVW CHECK 1/CASH RCVD BY DATE RECEIVED PERMIT 1 <br /> tlr s/ o� yi 9 �G �o'`' 3z 7 3 T2 i 9 <br />