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4AN JOAQUIN COUNTY PUBLIC HEALTH SERVICES / <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> -- __—_ <br /> FACILITY SITE NAME FACILITY CONTACT NAME <br />PI <br /> Mid Va17.O - Tra; lor Sales Robot-r hf:r tO <br /> C <br /> FACILITY ADDRESS SITE PHONE # With AREA CODE <br /> ?I -�'1 )'I ';'-]-soil ','aTr 209 <br /> T CITY STATE ZIP CODE # of TANKS <br /> Y <br /> itOC .ria nl��?l);; a[ SITE 1 <br /> A APPLICANT/BILLING NAME - --- - <br /> APPLICANT CONTACT NAME <br /> P .. .L "� '1':,:1::. "i'L1G 1,rcL1 <br /> L <br /> I MAILING ADDRESS APPLICANT PHONE # WITH AREA CODE <br /> C , . <br /> aOc._t(al va �1 <br /> N CITY STATE ZIP CODE TYP6 of APPLICATION <br /> I 1tnC _1:":l ;a CLOSURE, INSTALLATION, etc..,.,,;1-, , _:.L <br /> R$50.00/TANK <br /> TOTAL <br /> 1986 1987 1988 1989 1990 <br /> L FACILITY FEE (Prior to January 1, 1991) _ $100.00 <br /> $ <br /> FEE _ $50.00/TANK (prior to January 1,1991) $170/TANK (after January 1, 1991) <br /> ks 1986 1987 1988 1989 1990 1991 1992 19iply p byby fee foryear applicable) $SURCHARGE _ $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> s x $56.00 anaunt and year) <br /> $ <br /> C PERMANENT CLOSURE (Removal or Authorized CLosure-in-Place) TANK I.D. #(s) <br /> L CLOSURE FEE = $53.00 per hour (3 hours minimum per TANK) At TANK(s) X $159.00 <br /> O -- ) / <br /> kr <br /> REMOVAL & DEMOLITION Valley Commercial Bank 14 615 <br /> HWY. 99, NO. 206 931-6810 P.O.Dux 9400 $ <br /> STOCKTON. CA 95212 1031 East W.1c0..Rood <br /> Stockton,California 95208 <br /> ` <br /> 19_� � <br /> l <br /> 6 <br /> OFFICE USE ONLY <br /> .... »w.<: ;;aa ..�;.o;»,:»;w::.o... <br /> j s` EP°S` 'btY O P <br /> 77rbr <br /> x a aaaxa�a .wu.,.a <br /> a x <br /> a <br /> r a'mua'q:.aasxzrt sats aw axw xa vu ansa wa ansa raa aaztaw axi¢az'w axx arex�suars xs saama au axis axx a'mx an sm,x sro au uax.m.ie <br />