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SAN ,iaAOUIM C�JIITT PUBLIC HEALTH SEIIYIC <br /> / o <br /> EgVtNOWFNTAL HEALTH DIVISION <br /> RAGE TANK <br /> tADERGRCUMO STORAGE PROGPM FEE WOR T <br /> FACtLITT SITE N,AQME FACILITY CONTACT NAME <br /> A L/tit7 / /l��c2'i' T � f7 4 12 C�r�12L Gl f�I GG <br /> I FACILITY ADDRESS SITE PHONE 6 with AREA CODE /d <br /> S CITY rE lip CODE a of r L�.{,o 3(6 at ltto <br /> Te <br /> A APPLICANT/5E1LINO NAME APPLICANT CONTACT NAME � 0 <br /> 17 <br /> P M <br /> I NAiLlwg ADDRESS <br /> APPLICANT PROM0 WITH AREA CODE <br /> GS <br /> C 4r3/ ri�, f�rt rc /�Ci9� 2vZ <br /> !T TYPE of APPLICATION <br /> N CITY TE Zip <br /> CODE 'L S' <br /> CLOSURE, INSTALLATION, ate. "0 <br /> TOTAL <br /> A <br /> C 1966 1987 191515 1969 1990 <br /> T ANKUAL FACILITY FEE (Prior to January 1, 1991) a $100-DO <br /> t <br /> E <br /> V <br /> E TANK FEE + %50.00/TANK (prior to JrsAry 1,1991) $170/TANK (after January 1, 1991) <br /> F 0 Tanks 1986 19157 1958 19159 n <br /> 1991 1992 1993 1994 1995 1996 <br /> A (euttlpty 9 by fes for <br /> C each year appt(cable) ; <br /> I <br /> ion 25257 <br /> L STATE SMEKARGE ■ %56.00 each TANK (Due awry 5 yearn) See California H 9 S Coda, Sect <br /> t / Tonic* x $56.00 19156 through 1990 1991 through 1996 <br /> T (enter anmnt and year) _ <br /> PERKANENT CLOSURE (Neweovat or Authorliad Ctoaura-In•Pi m) TANK I.D. tl(a) <br /> C <br /> L CLOSURE FEE a $53.00 per hour (3 hours alnimA W TANK) 0 TANK($) - 1I 15159.00 a = f <br /> 0 <br /> 9 <br /> j O Of MOOESTO BANKING COMPANY 90'3732/1211 <br /> .JVFJ7/i MODEzoe"ST d, CALIF ORNIY\9]]]a <br /> SEMCO 5726 <br /> GENERAL ENGINEERING & ENVIRONMENTAL CONTRACTOR <br /> 431 W. HATCH RD. (2091 524-9653 <br /> MODESTO,CALIFORNIA 95351 E S <br /> R c¢ia <br /> PAY SEp�! .� ..,�. .P t} DOLLARS <br /> I41 V� .+,t G.�' .I• ,si�..a.i <br /> GATE CHI=CK NO. AMOUNT <br /> TO THE ORDER OF _ <br /> SE.MCO <br /> 414�l <br /> F-2 <br /> }�{r..w.www....��p.��_'/��:,�{ili..�i::.�i»w wwwwr.wT.ni..nww:+w LC w+n.i..w�wi:i�a[�+I�i�..'.�Z'i..��"...s�. "+�. �wl.+r iwiw�i+�i'i.w wt7�.[»t>�.ii►y�wr l�w�ii u.+w.w w..w�+.:.�:. <br /> �MS�EI"i ■ I.rTVIC1{� �. �r>rY � .� !, �� �M <br /> a <br /> ............r I.w.ww rw.w»rw ww M...r w Y n«w>y a..w�w.r lww w.r.+..�..rw rr Mrlw w a.w.■w ani sw.,�it Iw!>rw,.. >...Iw.u,Iw w nww l.n>.ww Iw,�A rr www R..>rM tw+�. <br /> A"wr mow ar a]Nr rwM s.r ar wM•sr arwr M awe al Gaal aM all aww oar allle air aeon err air ells aero aM oleo rr earn err Ale naw Me oral nr anal as naw IMall ap rarer air All1i ea/af arw R <br /> i <br /> EK 23 032 (REV 4/8/91) ft Paan 11 L/ <br />