Laserfiche WebLink
/51 TE NAME <br />1C.YlLLavT /Ti�f-J JIG <br />AT ADDRESS <br />(CITY _ S1 <br />A APPLICANT/PILLING NAME <br />P n�y <br />P S J I C_—SL11oCy— cJc s4, <br />I MAILING ADDRESS <br />i <br />WESTERN METER SERVICE, INC. <br />2735 TEEPEE DR, SUITE E <br />STOCKTON,CA 95205 <br />(209) 948-6124 <br />FACILITY CONTACT N' <br />-- SITE PNDII�E I WITH AREA CGDE <br />ZIP COD I of it—antis <br />s aH 7 <br />i20 at Site — -- <br />IAPPIICANT CONTACT NAME <br />APPLICANT PHONE I NIT" AREA Coot <br />DATE INVOICE I AMOUNT <br /> <br />10064 <br />PAY DOLLARS <br />Rnoss nH �cM CHECK AMOUNT _ <br />DATE TO THE ORDER OF DISCOUNT/�/ Otu[n Cif. YA'�ARL[ <br />WES N METERz <br />, INC. , <br />UNION SAFE DEPOSIT BANK <br />STOCKTON• CALIFORNIA , d <br />IIE _ <br />_ ..,..VV CC,.R Inm. I Tank s_Tx 130.00 I _ .-- <br />U <br />R TEMPORARY CLOSURE (Only allowed one time (or up to two years) <br />E <br />TEMPORARY CLOSURE FEE 100,00 each TAH); 1 Tanks x 190.00 f <br />P PLAN CHECK (Installation or Repair) _ <br />L ----- <br />A <br />11 PLAN CHECK FEE = 130,00 each SUBMISSION/RESUDMISSION f <br />F. TANK REPAIR FEE = 1110.00 each TANK 1 Tanks m 1110.00 1 <br />E— -- .... — — --- — — ...... ------ <br />A PIPING REPAIR./CLOSUP.E/P•EMOVAL (Fees are per (tour, minimum one hour to be paid on plan submittal) <br />R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br />(when applicable) (when applicable) Iwhen applicable) <br />FEE = 00.00/hr FEE = 135,00/hr FEE = 13S.00/hr 1 <br />TOTAL DUE f �0 <br />OFFICE USE OMtY <br />SNEEP9`1 IrCCP In LOC CODE 11111ODE AMOUNT DUE AMOU))IROD I cmErr. I/H I RCVDfBY I DATE P,ECEIVED PERMIT I <br />