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z--- �— -- <br /> RICH - MART 10663 <br /> JIM THORPE. DISTRIBUTOR OF QUALITY PRODUCTS <br /> Q-� 368-6175 462-4581 <br /> - - -1 - - 351 NO. BECKMAN ROAD, P.O. BOX 357 <br /> -- -- -�f LODI, CA 95241-0357 9 q/� W10YI211 <br /> PAY <br /> TOTAL TO THE <br /> I ---- _ ORDERO ao� � $�C--/.� <br /> AMOUNT OF CHECF a ��� <br /> _�DOLLARS <br /> Bank.`fl.�wck wn <br /> lUOi OIFlCE <br /> 131 W.WJnm 8.,LWi,U A53N <br /> FACILITY FEE = 1100.00 each SITE ADDRESS per YEAR TOTAL <br /> A — <br /> C 19D6 1907 1988 1989 <br /> I <br /> I <br /> V ' G� �' �OQ f <br /> E TANK FEE = $50.00 each TANK <br /> F I Tanks _ 1 $50.00 1906 1987 1980 1989 <br /> A (sultIply-'-by lee for <br /> I each year applicable) <br /> L STATE SURCHARGE = 156.00 each TANK (see CA HEALTH L SAFETY CODE Sec 25287 for applicability) <br /> I <br /> T 1 Tanks _ 1 $56.00 1986 1987 1900 1909 <br /> Y (enter mount and year) <br /> C { <br /> C PERMANENT CLOSURE (Resoval or Closure-in-place) <br /> L —_ <br /> 0 CLOSURE FEE = 190.00 each TANK <br /> 5 1 Tanks a 190.00 { <br /> R TEMPORARY CLOSURE (Only allowed one lite for up to two years) <br /> E <br /> TEMPORARY CLOSURE FEE = 180.00 each TANK ants s $80.00 S <br /> PPLAN CHECK (Installation or Repair) RECEIVED <br /> L <br /> A <br /> M PLAN CHECK FEE = 130.00 each SUBMISSION/RESUBMI NAR , IN C011NTY $ <br /> REPAIR ENVIRONMENTAL H <br /> R TANK REPAIR FEE = $110.00 each TANK 1 Tanks _ r 1I10.00 { <br /> E <br /> P — <br /> A PIPING REPAIR/CLOSURE/REMOVAL (fees are per hour, einieus one hour to be paid on plan subeittat) <br /> I <br /> R UNAUTHORIZED RELEASE EVALUATION CONSTRUCTION INSPECTION SAMPLING INSPECTION <br /> Iwhen applicable) (when applicable) (when applicable) <br /> FEE = 130.00/hr FEE = f35.00/hr FEE _ 1135.00/hri. { <br /> TOTAL DUE { <br /> OFFFCF Off ONLY <br /> SNEEPSI COMP 1 LOC CODE 01ST CODE AMOUNT DUE AMOUNT RCVD �LI K�/CASH RCVO BY DATE RECEIVED PERMIT <br />