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I ie I C7 <br /> ' ~ Llt(6 4. 1-1 w aSAN JOpgU <br /> ERGROIN COUNTY PUBLIC HEALTH SERVICES <br /> - GROUND STORAGE TANKPROGRAM <br /> ENVIRONMENTAL <br /> FACILITY SITE NAME EE WmKSH� <br /> F <br /> A Stockton Trarmpc)rtatlon Refridgeratzorl FACILITY CONTACT NAME <br /> C Rene Welsh <br /> I fACIL[TT ADDRESS <br /> 1 4808 S. Hwy 99 SITE PHONE 9 With AREA CODE <br /> T CITY (209)946-0648 <br /> Y STATE ZIP CODE A' of TANKS <br /> Stockton r <br /> A AFPLICANfJ81LLIHG NAME Ca. 95205 at S eW <br /> P <br /> P Hiram Jewart APPLICANT C ��1 <br /> L 4 �m Jewart <br /> I MAILING ADDRESS 2 <br /> C <br /> A 11200 N. ilwy 99 APPLICANT PH <br /> N ctrr 20 it)11200tri ;- Q�C�S <br /> OIV1SION <br /> T Loll STATE Zip CODE 0KATION <br /> Ca 95240 asl1RE, INSTALLATION, etc. Removal <br /> A <br /> C TOTAL <br /> T ANNUAL FACILITY FEE <br /> r (Prfvr to January 1, 1991) = $100.00 1986 1987 1988 1989 1940 <br /> V <br /> E TANK FEE = 350.00/TANK3 <br /> (prior to January 1,1991) 1170/TANK <br /> F M ranks (after January 1, 1991) <br /> A1986 1987 1988 1989 1990 1991 1992 1993 1 <br /> (multiply U by fee for 9941995 1496 <br /> C each year applicable) <br /> I <br /> L STATE SURCHARGE - 356,00 each TANK 3 <br /> I _a_ (Due every 5 years) See California N & S Code, Section 25287 <br /> T d ranks x 356.00 1986 through 1940 <br /> Y (enter amount and year) 1991 through 1996 <br /> t <br /> PERMANENT CLOSURE (Remova( or Authorized Closure-in-Place) <br /> C TANK 1.D. ! <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> .. ........... <br /> x *WON <br /> ... . ................. 3 r 00 �� <br /> ... f' - <br /> /IeJ R'X1°h?771A'!lebe(�1K likN1Y}Ox}M1tf llAftY w "WWx iw►aww MM aw 'aww ay••••••••••• G J Z <br /> 7f1AMf 1141!aN twrw 4w aww "y,,, ••• .... .,.. ...1,.... �!1 <br /> 7MMX 7Ftl1+7WAr MAf A4t IW1Jli 1hC lM�AUt?w�M aw awai 11w llw rw�aN 1Mwi 1.iF Mlni••••••••... •• r <br /> a' <br /> fYlill[fYEti il11Y f1Mlf Melt ltdbNr AEIw <br /> Aw a4 atiy' 'y..: •.•••.............. <br /> EN 23 D32 (REV 1/10/911 ft �*�'��wr�w�row,vs�r��P, <br /> Pane 11 <br />