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SAN JOAQUIN LOCAL NCALTII DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - EEE WORKSHEET — <br /> r rACILITYISITE NAME FACILITY CONTACT NAME <br /> IA <br /> C k gUIN1'FROTS AU'PO DISMANTLFRS I'arguerite Juarez <br /> I <br /> L STREET ADDRESS S aNj NIrN a"e" eeee <br /> 1 2966 Turnpike Rd Stockton, Ca 95206 SIT`+fllUN 731 (209) <br /> Y CITY STATE IIP CODE I of Tanks <br /> Stockton, ;KCA at Site <br /> A APPLICANUDILLING NAME V APPLICANT CONTACT NAME <br /> p Jessie 4uintero Marguerite Juarez <br /> P <br /> L ---- - — ——�.-- 'r —p6� <br /> I MAILING ADOP Sgg APP 7 PIIp4Tt BNT ""c" tape <br /> I' rJ000 turnpike Rd. - ) Y 1 <br /> A — — --� <br /> R CITY ggtATE p LODE TTP[ of APPLICATION <br /> Stockton __'-----_— CA 9j 06 CLI)i IMe T"ll"FIeN. RTC, Closure <br /> FACILITY FEE 2 1100,00 each SITE ADDRESS per YEAR TOTAL <br /> n -- <br /> C — 1906 1197 1900 1101 <br /> E TANK FEE 1 150.00 each TANK <br /> f 1 Tanks T 150.00 1106 1701 1100 1109 <br /> A (cullipli ( by lee ler -- <br /> 1i each year applicable) rJ �, �_(] { >�Q, (� <br /> I. STATE SURCHARGE = 156.00 each TANK (see CA HEALTH h SAFETY CODE Sec 25207 for applicability) <br /> I ITanks 1 a 156.00 1706 1 1707 <br /> Y (enter aiounl and year) , <br /> IPERMANENT CLOSURE (Removal or Closure-in-place) <br /> O tLOSURE FEE • 110.00 each TANK 1 Tanis 1 170.00 <br /> QUINTERO'S AUTO DISMANTLING 1458 1 <br /> 2968 TURNPIKE RD. 466-4673 <br /> STOCKTON, CA 95206 p <br /> PAY TOTNf ff-�+3 <br /> ORDER OF _ !/(••� <br /> DOLLARS <br /> UNION SAFE THE SUM 8 1](ir,•j 0 0 r <br /> DEPOSIT BANK t <br /> 322 E.Mein St..SlocMon.CA 85202 <br /> 1: 12 1 l0 108 2 1: 14 581II i0 56 5 2006 <br /> I.1rt[ ' 130.00/lir L IFEE = 135.09/hir IFEE 2 {35.00/hr 1 <br /> TOTAL DUE I i0ef 6 , D 0 <br /> OEFItr DTr OAIT <br /> 0190011IIT <br /> SREEPS 1 COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT ROD CHECK /CASH RP•VD BY DATE RECEIVED PERMIT 1 <br /> Ffv e II�IVP@pI :� 7 � . <br />