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DERtRLL1AJ STORAGE TANK rnuGKAli - IU. Nunria <br /> tIkACILITY/SITc WE <br /> ....._.'-----.Iiai,,.i iY CUNTACI KAiiE <br /> I. STREET DDP,ESS SITE . JONE t WITH AREA N(Ii <br /> YCITY .......__ —..._........—p�C __._.. . <br /> STATE TIP CODE i of Tanks ---� <br /> ~'APPLICANT/DILLING NAME ._...... <br /> PAPPLiCnNT CONTACT );AME <br /> P C _..�.AC-af �p1r <br /> 1 MAIL�NG AOD�P,C1SS APPLICANT PHONE L WITH A coon <br /> A._...Yf._) i111� ,�.t_Q�1? ______._. �7 u c I <br /> N CITY -------_._-,r1tU <br /> I _ :TJ,TEi EIP CODE �T AP Li�:6TIi1N <br /> C - 1a9u9 IReuuenon, erc. <br /> FACILITYFAI,TLITY FEE^= SIO0,00 each SITE ADDWS'S per YEAR — - --- —� <br /> _._.._.. ... — ...... _ MAL <br /> AL <br /> T 1386 I 1'387 <br /> E TAfIK FEE = S50.UU e,iCh TAHY, _ -"— _ ------ <br /> F t Tanks x 550.00 <br /> 1936 1587 5i8 158'3 <br /> A (each year <br /> . by fee for .._--__— --- <br /> C each year applicanle) '---•--- I —i-. I <br /> L STATE SURCHARGE = 156,00 each TANK (see CA HEALTH & SAFETY CODE Sec 25287 for applicability) <br /> T d 'f;nes x 156.CIA <br /> 1556 � 1587 <br /> YI(eAter aaDunt and year) <br /> ---_- — <br /> C PERMANENT CLOSURE (Keaova; cr Closure-in-place) <br /> 0 CLOSURE FEE - V30.00 each TANK —_ Tanks -• sgo.o ---"-""--- —i <br /> _. I t Tanks 1 , .x ti`10.00 y �r�CCJ <br /> CRISP 'i ANK 'i ecS i IIVG - ---_— 1538 1 ' <br /> P.O. BOX 30487 931-1828 —� <br /> STOCKTON, CA 85213 <br /> --"- <br /> PAY <br /> ''f'' <br /> ORDEN F-5). (/� .'" <br /> !T. Valley C�Dmmcrciai Flank - <br /> 1081 Maul W.9700 <br /> Ifn.d <br /> 9WekWn,C.lif..i.96209 �l <br /> fDTAL OUE f <br /> OFFICE USE ONLY <br /> y�4V!IpGI;IIGIIGGGNGIuIiIIDtiVIdUVilluil:IVlliillGiiIVIN9'IIIW a�uW�iiiG�yuIIGVIVIGIII�IIGVliuii]iilVuuiG�ICVAiti,idVi4iVliliG�GIVIGIGIIVVWV�ftiIVidVuiu�luWiUl�fdVVulwii�VGI�ViVUlui,iiVVIG�VG�IpGVGWiVViuIIGGVVGV6J!IVVVuliVu4iltil�tlluu�Gi1�iViuiwiiuu14w4ioVu�'q.@' <br /> SWLcPS t CONT' 8 LDC CODciDIST COOLi AMOUNT DUE AMOONT RCVD CHECK t/CASH RCVD BY DATE REPE,'vL., PERMIT i — <br /> I <br /> Mull, �, VIGi�'� I�GVI`I � uaiIVGIV1�wuvulu IlPJulliwRivuixiGh�VV wuu�u�V: 4mh9�uouJ��muWuGIV�IIviwww,mmw;,a �IU�GGutIWu�'m'�uuIT WIVuvJul ':.,ilVmwulWdilmuVVGbVu w urvGllwJ ui � <br />