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SAN 3`.4QUIN LOCAL HEALTH DIS,,(ICT <br /> _ UNDERGROUND STORAGE TANK PROGRAM FEE WORKSHEET <br /> rjjr ILITY/SITE NAME FACILITY CONTACT NAME <br /> SPINGOLO WAREHOUSE CO. INC. Frank Spingolo <br /> --- - <br /> L STREET ADDRESS SIttE PHON 1 WITH Amma coo■ <br /> 1 1011 11. Broadway (209 465-5675 <br /> y CITT �TE IIP COBE 1 of Tanks <br /> Stockton _ 95205 1at Site I - <br /> A APPLICANTIDILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P Larkin Construction Company Terry Larkin <br /> L ....---- -- --------- <br /> 1 MAILING ADDRESS APPL � T P�011E WITH Asea CODE <br /> [ P.O. Box 5280 �Z09) 4�4-2119 <br /> N CIiY STAT IIP•CODE TYPE of APPLICATION <br /> I Stockton CA CLDeuNE, IN/TALLATION, ETC. <br /> 9.5205 Removal <br /> FACILITY FEE $100.00 each SITE ADDRESS per YEAR TOTAL <br /> 1 — 1106 1987 I 1908 �—_1989 �-$ <br /> `I — <br /> E TANK FEE a 150.00 each TANK <br /> F 1 Tanks a 150,00 1986 81 1 <br /> A OuI11pTr 98f1 1989 <br /> 1 by lee for 19 — <br /> C each year applicable)— I_ —�— <br /> L STATE SURCHARGE a 156.00 each TANK (see CA HEALTH I SAFETY CODE Sec 25207 for applicability) <br /> I 1 Tanks a 156.00 1986 190711908 lie] <br /> Y (enter iiiiit and year) <br /> _----_� {— — <br /> [frC ERMANEHT CLOSURE (Removal or Closure-In-place) <br /> —_ ILIrrarrrnr <br /> LARKIN CONSTRUCTION COMPANY 1165 <br /> 951-1643 OR 474-2119 <br /> P. O. BOX 5280 $ <br /> STOCKTON, CA 95205-0280 / qq <br /> iE <br /> DOLLARS <br /> UNKM <br /> OEEKXITT <br /> 12136MK l r -_- <br /> ISID N EI Wr.M SI..SIMNn.CA SSt02 �-- <br /> -512l l l <br /> : <br /> TOTAL DUE <br /> OFFICE ISE ONLY <br /> SWEEPS I COMP I LOC CODE DIST CODE AMOUIIT DUE AMOUNT RCVD CHECK IICASH RCVD BY DATE RECEIVED PERMIT 1 <br /> 0o L c„S Tvl K f — 1 <br />