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SAN#oUIB COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEROIN DIVISION <br /> UNDERGROUND <br /> STORAGE TANK PROGRAM FEE IAJRKSNE Ei <br /> FACILITY SITE NATE FACILITY CONTACT NAME <br /> ! ✓ ta_ <br /> A Robert Lord Bill Lord <br /> I FACILITY ADDRESS SITE PRONE / vlth AREA CCOE <br /> L 428 W. Pine St. (209)01478-4515 <br /> I <br /> 1 CITY STAIE 21P CODE / of TANKS <br /> Y Stockton, Ca. 95204 at SITE 1 <br /> A APPLICANI/BILLING NAME APPLICANT CONTACT NAME <br /> P RoBert M. Lord <br /> P Bill Lord <br /> t <br /> 1 MAILING ADDRESS APPLICANT PHONE / WITH AREA CODE <br /> C 434 W. Pine St. (209) 478-4515 <br /> A <br /> N CITY STATE 21P CODE TYPE of APPLICATION <br /> I stocktoll, Ca. 95204 CLOSURE, INSTALLATION, etc. Removal <br /> A TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> I ANNUAL FACILITY EEE (Prior to January I, 1991) SIO0.00 <br /> I � 1 <br /> V x x x x x x >00.0(1 Lw _ <br /> E TANK !EF a 1150.00/TANK (prior to January 1,1991) 5170/TANK (after January 1, 1991) <br /> F M Tank, .1_ 1986 1987 19BA 1989 1990 1991 1992 1997 1996 1995 1996 <br /> A (mdtlply 0 by fee for — — _ _ <br /> C each year apPUeable) x x x x x x B ZcJS� <br /> I Nd7 00 <br /> L STATE SURCIIARGE • 156.00 each TANK (Due every 5 year,) See California N 1 S Code, Section 25287 <br /> I <br /> I N tanks a 156.00 1986 lhrou9h 1990 1991 through 1996 <br /> T (enmo <br /> ter eaot and year) <br /> x t 112.DC Luj c� <br /> PERMANENT CLOSURE (Remove( or Authorlted Clowre-In-Plate) TANK I.D. /(,) <br /> C -- <br /> L CLOSURE !EE • 157.00 per hour (J hours minlnam per LANK) / TANK(a)_� % 1159.00 1 l 1 v <br /> 9 159.00 <br /> `'JIM THORPE'OIL INC, 13322 ; <br /> N.,• ���� u OISTRISU'fOR Of QUAL" PRODUCTS <br /> 351 NO.C' BECKMAN RD. 368179 4624581 P O. BOR 357 <br /> LODI CA 95241 <br /> 90-844/1211 <br /> T9 <br /> PAY' - _ . .. _ 2 ,., . <br /> - <br /> TO THE r <� <br /> ORDER _ <br /> B eP <br /> FARMERS & ` <br /> MERCBANK ANiTS ^'y <br /> iofAl DUE 1 �/ ��IpO <br /> OlFICE USE ONLY <br />�...a.�w+rwr.�.rraaar/�.a..aw�rr�•.w�wer��arr wi r.����.a�n�.a�r�µa�..wM'r:w.+�w��`awn"a::a:�iwiawr�iaiAraww,w�"ar�a�.+y...��a��yl��M w.�..a.��a a..ya_A�r���..... r�N_yr��_a��alM_v_ <br /> f4ttf'S .r llltl'V(tN I lDC UI51 I.lAlt •.• AHlA1N1 NlW ln[lK a�A�II Nk1.tIVLU tlT � � UAIe Ntlt 1YLU M <br /> M .._...........__.... s.. ..............r.033 27, - <br /> wwr.•ww W•• •••r•ti•rr r•.r•w.r�,•,r r•r MM•'w..�•'„•••••'•'_'•••••'••• •••u.i_ ....••n�...— M• % a <br /> M <br /> W MM•MMeMMMM MA11anMMa W MIrM MkMMMMMMMMMMYMMiaMMYMIY/MMMMMNMItMIM(M MAIMMMMMMMMA�aaMMMYIMM <br /> A nil rare tilnioll If Psae I 1 <br />