Laserfiche WebLink
SAN OVAQUIN LOCAL HEALTH DIdRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> �.r FACILITY/SITE NAME ��} FACILITY CONTACT NAME <br /> i .._-.. . CHEVRDJ SER.vI& STA FF MART I EZ� E1 gClc7 <br /> L STREET ADDRESS SITE PHONE I WITH AREA CODE <br /> Sog k_(:lto.�'fe1Z kin, &3, n j, (7-09) 4(oZ- 1191 <br /> Y CITY S C>Lk O� PUB JpA T TIP CODE 1 of Tankz <br /> T T fNVi'QpNMFHEA "• �(o at Site 3 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> i Ro6F-12-T k . Lcc -i6sc<:A&7E✓6 """01 <br /> fZlr 1 I Gjc �t.� <br /> I MAILING ADDRESS APPLICANT PHONE I WITH AREA COOT <br /> A —1337 1 �o�d� ,4yE A 211 110- (04(0-4C)D3 <br /> R CITY GA, -p — STAT JIIPP'CC0� TYPE of APPLICATION � vAl e <br /> CA c�Oevee, tNETAIIAT[DN. Erat�T^NIG 1� I <br /> FACILITY FEE _ $100,00 each SITE ADDPESS per YEAR TOTAL �•J <br /> A ---- ——._. --- — <br /> C 1986 1931 1988 1389 <br /> TJ- <br /> P <br /> E TANK FEE _ `A,9p ach TANK, dp <br /> F1 t Tanks _ _ x "NO 1486 774_q1968 A (sultipTyIby fee for --C each year applicgblel ------.- -- - -- ----- - - <br /> <br /> EXPLANATION AMOUNT <br /> ROBERT H. LEE III ASSOCIATES, INC. 2284 <br /> 1331 ROWE AVE.,SURE 211 <br /> SACRAMENTO,CA8512E a I f <br /> 1111)14&4003 C tJ c3 Gr` 19 <br /> n PvUb'^"TJ Vc VQ.hyV/��'G� / r l k-)- wA �,�I CHECK <br /> Y <br /> /� 1Y 7/ � /"tl OII013 AMOUNT <br /> IOUNFL <br /> F rS� C„A 1�4 �1 V�h �ldtc� /I <br /> TO <br /> ORDER ! �z, /"/ 1��I 1 Lfi � v <br /> C O <br /> pF <br /> SACRAMENTO OFFICE - <br /> WE�EQ�U(1610 AROEN WAY SACRAMENTO,CA 95866 <br /> r.0 DIA rcc - T11V.uU each TANK � I Tanksx $110.00 f <br /> IA PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> iR UNAUTNORIIGO P,ELEASE EVALUATION CONSTRUCTION INSPECTION I SAMPLING INSPECTION <br /> (vhen applicable) (vhen applicable) (vhen applicable) <br /> FEE = 130.n0/hr FEE _ $35.00/hr 1 FEE _ t35.00/hr s <br /> TOTAL DUE $ / b" <br /> OFFICE USE ONLY <br /> ° BMW" a adN .' I 11111 MOUSER <br /> SER <br /> SWEEPS 1 1 CODE DIST CODE AMOUIIT DUE AMOUNT RCVD CHY /CASH RCVD BY DATE P.ECEIVED PERMIT I <br /> 177 <br /> '73F�. ._ a �c l A-q-g I IV—�— <br /> �I?IT, � iP 9+g �IR�9�@ ! aq�n�... I�N"+ " . tV�lGp��r P@�@l�RIilre ;� Ifl8�19 fiMI�VG�IV I�dllQlfl�ll��4�9�1 .�DIIR�IfiGi OB@1�Mt <br />