Laserfiche WebLink
SAN JOAQUIN LOCAL HEALTH DI,w� NICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> f FACILITY/SITE NAME FACILITY CONTAL NAME 5 ��D/ <br /> C Mid Cal Tractor John Gilligan D CId�l,� <br /> L STREET ADDRESS SITE PHONE I (with Area e) <br /> T 1120 West Charter Way 209-944-571.4 AU 0 <br /> Y CITY STATE IIP CODE 1 of TANKS <br /> Stockton CA 95206 At Site 2 ( ry)zc :,,i,!--h1AL I-ILALTH <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME E�1YV <br /> P Petro—Check, Inc. David A. C stle N <br /> L N <br /> I MAILING ADDRESS APPLICANT PHONE F(with Area Code) <br /> C 2076 Acoma Street 916-92.7-1788 <br /> N CITY STATE ZIP CODE T PPLICATIGN <br /> ! Sacramento CA 95815 Closwre Installation, etc.) Removal <br /> A FACILITY FEE = $100.00 each SITE ADDRESS per YEAR N/A TOTAL <br /> C 1906 1587 1388 1989 <br /> 1 t <br /> V <br /> TANK FEE = 550.00 each TANK <br /> F . Tants z $50.001986 1901 1509 1985 <br /> A (aultip!y A-by fee for <br /> each year applicable) If <br /> L <br /> STATE SURCHARGE = $56.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 15:87 for applicability) <br /> Tants 1 156.00 1986 1987 1988 1989 <br /> Y (enter aaount and year) <br /> i <br /> C PERMANENT C!OSUkE (Reaoyal or Closure-in-place) 1 <br /> L <br /> 0 CLOSURE FEE = 130.00 each TANK 1 Tan1,s__2__ a $90.00 t 180.00 <br /> PETRO CHECK. INC. "( ) ►(� � ��(-2666 <br /> 800-348.4839 <br /> 2078 ACOMA STREET �'7� _ <br /> SACRAMENTO, CA 95841 "\ t 11-24/391 <br /> 19,2° 1210 <br /> PO,AWY 070 77-IE <br /> OFSJPHS 06 <br /> ;Zj o a<1 DOLLARS <br /> SOUTH NATOMAS OFFICE <br /> W.FLLS FARGO B <br /> 1532 W.EL CAMINO AVENUE,SACRAMENTO.CA 95M <br /> MR IA / <br /> TOTAL DUE t 180.000 <br /> yyy�F�yyyOF£IC£ !!SE OYLY <br /> .ry:., . : '�M' :... .,� �r I • N �qN Yr!IIM1'.,k /71.'F IhtA.u.9'Yo •I N•. nu•,i <br /> TOrruc 7 1C7MP ! LOC CODEInTST CODE AMOUNT DUE AMOUNT RCVD I CHECK WASH RCVD BY DATE RECEIVED— PERMIT I 4 <br /> Icv7 'Ail)c-Atl <br />