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SAN JOAQUIN LOCAL HEALTH DISTRICT ? <br /> —�— _ UNDERGROUND STORAGE TANK PROGRAM - EEE NORKSIIEET o-1_ <br /> r FACILITY/SITE NAME FACILITY CONTACT NAME <br /> IA <br /> r, C QUINL'ERO'S AU'1`0 DISMANTLERS Iarguerite Jun P.z <br /> I <br /> L STREET ADDRESS SITS fjIQN( 1 "'rM AREA einem <br /> I 2966 'Turnpike Rd Stockton, Ca 952.06 tdb+673 (209) <br /> r -- <br /> Y CITY STATE 11P CODE I of Tanks <br /> ICA Stockton, CA at Site <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> p _ Jessie Quintero Marguerite Juarez <br /> r <br /> L ------ - — -- -- — <br /> I MAILING AODR S APPk5 FIIIpo 87�" AREA emne <br /> 900 Turnpike Rd. k5 Y <br /> A . _ -- <br /> N CITY SSrrATE p CODE TYFC of APPLICATION <br /> Stockton --_---_-- CA 906 cLo.uRT, I"ITAlUI10", etc. Closure <br /> FACILITY FEE % 1100,00 each SITE ADDRESS per YEAR TOTAL <br /> C 1906 1907 1900 1903 Is, tF <br /> r — <br /> E TANK FEE : 150.00 each TANK <br /> f I Tants 1 a ;50.00 1706 1701 1900 III <br /> A (nillipli I by lee for <br /> li each year applicable) ��-� _ � � �;C> j i� ,j O S �•j�, (� <br /> L STATE SURCHARGE _ ;56.00 each TANK (see CA IIEALiN h SAFETY CODE Sec 25207 for applicability) <br /> I 1 Tanks a 156.00 1706 1907 1700 1709 <br /> Y tenter iiounl and year)---- ----_�� t UC <br /> - --- — --------- <br /> I r[PMAH[NT CLOSURE (Removal or Closure-in-pla(e) <br /> N CLOSURE FEC • 110.00 each TANK 1 Tanks a $10.09 ; 0 0 U <br /> QUINTERO'S AUTO DISMANTLING 1458 <br /> f <br /> 2988 TURNPIKE RD. 7488-4673 <br /> STOCKTON, CA 96208 //nw 19 ��9�/1�7121t <br /> PAY TO THE <br /> ORDER OF <br /> DOLLARS <br /> UNION SAFE THE SUM 8 �' 17 ;! a <br /> DEPOSIT BANK 4© �) ; <br /> 327 E.MSIP SI.,SIOCkIon,CA 85202 <br /> 1: 121E 10L0821: IE458"I 1056 52U'06 <br /> I.1 130.00/ <br /> lir= 170.00hr FEE : 1]5.09/hr FEE _ ;75.00/hr11 — <br /> -L_ J_- L- _-_.-- � <br /> TOTAL DUE ' I <br /> OFFICE DSE DAY <br /> I�II@0!RI I�MCI�III�EIIIi�i�i!'� 9Iw !N'IC , I ILII ��prllE�l6i�.�BP�iEIIIA iii . (�I , . Ip�p I�RI'A?]f�9AQA�" <br /> SUEEPS I COMP LOC CODE ST CODE AMOUNT DUC AMOU RF,VD CACP, 1/CA CVD BY DATE PECT.IVED PEPMIT <br /> Qj <br /> uVi � .� �_`� 1 ��- VS s-Is-�ic� ti /3 _. � <br />