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SAN JOAQUIN LOCAL <br /> UND 'GROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> FACILITY/SITE NAyE -n..-. ---_.__._.--•--.__.__.__._..._._..__.. €AGILITY CGNTAAME <br /> L STREET ADDRESS SITE PHONE I utTN AREA COU[ <br /> T ___—.----.--_._.. _..._....__. <br /> Q2, 2105— <br /> Y CITY ST TE IIP CODE I of Tanks <br /> -at Site- <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P p <br /> I MAILING ADDRESS <br /> r APPLICANT PHONE I IIrrN AREA CODE <br /> ! C S__._......-......c_--I ----- -- <br /> p....._.....-__...._..._...._........_...,._....__._.........._._.. -- <br /> N CITY STATE iIP'CODE TYPE of APPLICATION <br /> T - CLOSURE, INSTALLATION, ETC. <br /> FACILITY FEE = $100.00 each SITE ADDRESS per YEAR - TOTAL <br /> A _._........._....___......_.__..._...-........ <br /> .........._.._....._ <br /> C 1336 1981 1983 1963 <br /> r ----------- <br /> EI I <br /> E TANI FEE = $`0.00 each TANK <br /> F I Tanks _ Y $50.00 1936 1981 1933 1933 <br /> A (m u 1 t i p Ty A by fee for <br /> each year applicable) S <br /> L STATE SURCHARGE = 556.00 each TANK (see CA HEALTH & SAFETY CODE Sec 25261 for applicability) <br /> I .............. <br /> T I Tanks j z $56.00 1.336 1961 1933 1939 <br /> Y (enter a-punt andy ear) ----------------- <br /> _.--•---._._----------.__ _. _ _..._._ —._._ _.__ _ _ _______. ___ <br /> S <br /> ........................._..___.._...__....._._._... .__-.,. _ .. _ .____,_-._-__-._-• — <br /> MORRIS LAND CO. —DBA MORRIS MORRIS DAIRY f <br /> 19 MACOMBER RD. _ <br /> DANVILLE, CA 94526 z Z 1 gt— 90_203/1211 - <br /> PAY TO THEcsso• .0 -G � (.��I _---- <br /> ar <br /> _,z DOLLARS <br /> i <br /> THE MECHANICS BANK <br /> F.I.SORRANTE 0F11CF <br /> iNP9 NN PA1310 RAM NOAH <br /> EL SORRANTE,CALIFORNIA 94803 ....–.._..._,„.___.. .Y._..._.—._.___.__.____._.._ <br /> MEMO. - G <br /> n rirmu r.CF9[rTM-UZUiSC/FCflUYRL lree5 are per 179url minmum-urly nour iII"�TmT pidn 5uumittal) _ <br /> I.................._._.._.._.._.__....._...._.._,..._.._._........_.___._.__..____..._.._._..._._._....___..__..._.__._._--..._....--__._ <br /> R UNAUINOR.IZED RELEASE EVALUATION CMNSTRUCTION INSPECTION SAMPLING INSPECTION <br /> (vh. applicable) _..._..._..._._...._......_n applicable) When applicable) <br /> .€EEe.... p41 r . _.._.._.. FEE _........_..._._......._... _..__.._...... - -...___.......__ _ .._...__.._.__... .. _ _._..._..._,_ _..__.................._...._.. <br /> 335.1)0/hr FEE - $35.00/hr f <br /> ff - <br /> L..........._......._.................__.........._........._._........................__._.._..._._..._....._..._....__...._..- -........._... _-._ —.._...._.........,._........_.. -__ _......_....._..._..._.--_._.. <br /> TOTAL DUE — <br /> OFFICE USE ONLY <br /> I€I'1a111,' 11!!1nl l 191PPRAtiani!I!�! uRli!IIS15111i119111I1�1111INiI'll0911 R115IIID►OT11ii!9'I1,1!'7MWIR!!49f!! � I !�IR.9lli511i�1111l1!!r4liillil� <br /> SWEEPS I f.pMF I LOt. CODE DIST CODE AMOUNT DUE AMOUNT R1,V CHEWY CASH R <br /> CVD BY DATE RECEIVED PERMIT I <br /> _... ........ <br /> 3',5-- <br /> _......_ ....._ _...__.... ._ _,. __ <br /> it >?�U' f ��e z�f /tet <br /> lN�raala r,�ia 1 nla as aataalauaalaa l�u��f,I aar����a��;�a as��� a�aa^.�a��� aal,�.1�a1a as�Iaa1 rat�a I ,1 �1 ��na a r11, la��1 � �� nlln'I!ii! 19111,!;!! Q11:i1 Ill�li,�l�ll nl�Ill.l 191!Ii1l�alil{,II�!l linin nilll�l!I1111nf11111�,ii!�11G�'7<I��11911111i18g11111�� <br /> L.,.. ; I �! , <br /> L � � 9,21'. <br />