Laserfiche WebLink
SA*OAQUIN LOCAL HEALTH 14TRICT `O <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE RRKSHEET <br /> IFFACILITY/SITE NAME Non - FACILITY CONTACT NAME <br /> �Q Raymond Rishwain <br /> I <br /> L STREET ADDRESS jX7 SITE PHONE 1 WITM AREA COOK <br /> I 48 N. Wilson Wayr- none <br /> TT - — ( STAZIP CODE 1 of Tanks <br /> Y CIT <br /> Stockton, CAT95202 at Site <br /> A APPLICANT/BILLING NAME - APPLICANT CONTACT NAME <br /> F'I Roy F. Weston, Inc . F,rik A. Friedrich, R.E.P. , R.E.A. <br /> F' <br /> L...__.-----_ ----------------- ---' -- APPLICANT PHONE 1 MITN ARCA cone <br /> I MAILING P.DDRESS <br /> I_ 83 W. March Lane, Suite 12 209-476-1635 <br /> N CITY Stockton RTE ;IP C D[ TYPE of APPLICATION <br /> 152$'/ CLOKVRC, IMETALLATION, CTC. closure <br /> FACILITY FEE - 5100,00 each SITE ADDRESS per YEAR, TOTAL <br /> A <br /> I, 1986 1981 1988 1'i89 <br /> `i o= <br /> 11 /00 16 JDD IK <br /> 9w D p <br /> v . ---- — —— — — — <br /> E TANK FEE - 150.00 each TAME <br /> IF a Tanks _ _ s 150.00 1986 1987 1988 1989 <br /> A (Rultipiy ► by fee for —" - - <br /> 1 each year applicable) ,j—"p as _S—O ,SO ou J5D 1 o900. Ch) <br /> L STATE SURCHARGE = 156.00 each TANK, (see CA HEALTH 6 SAFETY CODE Sec 25287 for applicability) — <br /> ( " Tanks___-- x 156.00 1986 1981 1988 1999 <br /> Y� (enter aaount and year) ---" -- <br /> --- ---.. <br /> C PERMANENT CLOSURE (Renoval or Closure-in-pla':e) <br /> L....- ----._.._- ----— -.._.----- ...._.-_-—.-- -----1--% 1.0.00 1 -- <br /> 0 CInSURE FEE = 190.00 each TANK 1 Tanks ' 90 . 00 <br /> ROY F. WESTON, INC. 1417 <br /> 83 W. MARCH LANE, SUITE. 12 <br /> STOCKTON, CA 95207 1157 695 <br /> (209) 476-1635 1210 <br /> PAY - <br /> TO THE ,1 <br /> g.g ORDEROFJ��P1/Lh.—_.,LC2�//G�/ _1��� D6l�ArE7>"�fiL_T ,�j �96.U0 <br /> aI ��r/�e/��Ua7.0.¢fQ_1�/wD ��✓.¢TY �!X --DOLLARS <br /> FistFirst <br /> Firs)Inlanwaln Bank <br /> of C9elarnl9 tl 695 <br /> Int -mfate <992 Azaum Aruna. <br /> cad FO.Gua 7495 <br /> Bank SWM.n,CA 95207 � e <br /> FOR - - <br /> .. —J <br /> OFFFCF USE ONLY 796'uo <br /> ��@m4�u�!AHI"GCAt�II�Pt9l�l'rel'�I"BP.r�'�'m�191�.�')9�4! IuIB'!�u9",IJ�iIl�l9@"uG6+N�'IR^SII!ulm"�il��l��!�lii� u!i61'til"1'"y�!I�1i�'�'1!Vf",'f�XIG'Nile"ul!Illi�i�."Tu6lfiilf"C1"�1111�9RN�1filillfiV!�HV� t!�u�IIuPIIG?1���!'I12��'h <br /> SUECPS " COME 1 LO( CODE DISI CODE AnOUIIT OUE AMOWIT RruD CHEtk A/CASH RrVO DY DATE RECEIVED � PERMIT e �V <br /> �nt•%<OuI(/dI I+1 m�^�M nT�I"I r�J,f III"IIi LIq pf� li �Iln'�'I�Ih ltl I IIN11 n'I IN' I n p rn l IMIV IPi plpnl I Im' I A 1If nl' T"nl <br /> ' 41 11' L��@:'It d:'16 iL7Y rllh'�'I1N I, .411;1�1'111.a.. 'il�'..i.l:'IiI II J.:�.I it 7..t A.41 PIId')�ti..ILr.O .,. '.I A��.IA'll li N.11IL U:IMIdIo.III uIPdI.dINIl�4��!.�I'I�ip•JIWIMW.L'llall eudll.inl�.i�'..I n <br />