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,ACILITY/SITE NAME <br />C OVN i OL/ <br />L STREET ADDRESS ,�/ <br />I /5/5 MO. <br />Y GITY <br />I"yi"gp1T(- Vel <br />- <br />A APPLICANT/BILLING NAME <br />P <br />P OFN�G <br />L— <br />I MAILING ADDRESS <br />C <br />N CITY <br />T /Wo 06S ro <br />u.-nrnyulM� �lYhnYL nl1n lhuuh/ilfi 1tL RYKh.7EitCi <br />FACILITY COO NAME <br />Ali jjAnI Aex 111%gN6 <br />SITE PHONE I (with Area Code) <br />MA /A/ 2]g66 7~ 909-;259-6,20--!:) <br />1'9uF. STATE I CODE I of TANK'S <br />/ �,� 1f lit Site <br />APPLICANT CONTACT NAME <br />,m r � �✓�J rli��nl T.s <br />�c.T�eC OWN/ G <br />APPL CANT PHONE #(,r't Area Code) <br />0441F, TVATEIZIP CODE TYPE of APPLICATION <br />I g53So2 (Closure, Installation, etc.) <br />C PERMANENT CLOSURE (Removal or Closure in-place) <br />L <br />S CLOSURE FEE = 190.00 each TANK # Tanks _ x 190.00 <br />SEMCO <br />TERRY HAMILTON, PRESIDENT <br />RICHARD C. HAMILTON, V.P. <br />PH. 209-524-9653 <br />431 W. HATCH ROAD <br />MQDESTO, CA 95351 <br />ER OF Z �C7� <br />UNION SAFE <br />DEPOSfT <br />BANK <br />�BM <br />rtlwaY. Sall yICA 95388 // <br />MEMO� <br />'1 - — <br />FEE = $30.00/hr <br />OFFICE USE ONLY <br />1511 <br />&j a 9- t <br />96 <br />(ry <br />OLLARS <br />ttal) <br />FEE = $35.00/hr IFEE = $35,00/hr,,, # <br />TOTAL DILE $ <br />