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.... � .. ..H..�..i.r 1._..d ML. r1L' riLin LIS IKJI. I <br /> LEE <br /> FACILITY/SITE MAME <br /> UNDERGROUND STORAGE TANK PkOGRAM <br /> f �- -- �_ - ----_�--- _„ ACT NAME <br /> C ' <br /> L STREET ADDRESS SITE PHI6NE Y NtTN ARE c <br /> Y CITYCODE I of Tanks <br /> .5a05. at Site _-Q <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME -- <br /> P <br /> I MAILING <br /> /1ADDRESS APPLICANT PHONEi MITN A Cooe <br /> N CITY Q <br /> T STATE 21P CODE T APPLiCAYION <br /> oeue tNe TAUATmN, ETC. <br /> FACILITY <br /> - ._.100-•-------1386 p_.. ET� <br /> 89 FACILITY FEE = $100.00 each SITE ADDP,ESS er YEART --� - -- i-- - - -- — <br /> I <br /> V -- <br /> E TANK FEE = $50,00 each TANK --- <br /> _..__...._.. <br /> ......._... <br /> F Y Tanks x 1986 1387 1988 <br /> fee for ---- 1389 <br /> A (rultlp(y-i by tee fnr ------ <br /> each year appltcabie) - - -- -" <br /> L STATE SURCHARGE = $56.00 each TANK (see CA HEALTH & SAFETY CODE Sec 25287 for applicability) <br /> T I Tines x 556.00 1'39b 1987 1988 1383 <br /> Y (enter 5il and year) _ 1 <br /> OICLOSURE <br /> FEP.MANENT CLOSUP,E (kenovalvr Closure in-place) _ <br /> —FEE = $90.00 each TANK 5-T anks ) _ . 590.00 $ <br /> CRISP TANK TESTING 1538 <br /> 311817 <br /> _ <br /> P.O. BOX 30487 931-1828 ----'--- <br /> STOCKTON. CA 95213 <br /> <br /> PAY /^ �------_--- <br /> 70THE. `Y <br /> ORDER OF <br /> - <br /> e ---- ---- -- -- . <br /> LAF?S <br /> Valley Commercial Bank - --- --- <br /> P.O.W. <br /> F. <br /> 1001 en WAbdrl.oo <br /> 9520 <br /> 9tockbn.CAlltorniA 06208/ a <br /> FOR m P Y'-�j'�. Y-'�'-e.� 0�4_� <br /> TOTAL DUE <br /> li OFFICE USE ONLY <br /> j ���II�I�QI�IgnNVI�fIN�6�IIIfVI:�VIfIIVI�i��I�IIIIO�Ii!II�Vif�llnil�ll�llflll�l@�Gl�illln�fl���ll�llilil�lliltlpl�' 'IIW��I�IIIIVV�GIVIiIIIIIp�V7Gl'i11V1iVIIli�IVII�IAII�IHII�I�II�III�IIIOUINI�I�INV�VIVi�uI�VMV11�8fV�IV11��111a�IWV�II�IGI�IV@Illui�ul�l <br /> SWEEPS I COMP I LOC CGDE DIST CODE AMOUNT DUE AMDUNT kCVD CHECK WASH RCVDBY DATE RECE0EU � PERMIT I <br /> FD 1 ill ;I� (� I� " 9b�iliiu�9Vll9�' IVVIII II�JIUIIiI��h��lu�li�Dl�l�Q VIWVVi6��V1191I�IG�V�V�IIUVI�I�VIIQVIViIduI'll @II���11� i 1fVi9 11ull UIT1011RMpJ11111 IVV�Iu1VVL9� 1C111 <br />