Laserfiche WebLink
•N JOADUIN COUNTY PUBLIC HEALTH SERVICES • <br /> ENVIRONMENTAL HEALTH DIVISION <br /> UNDERGROUND STORAGE TANK PROGRAM • FEE WORKSHEET <br /> F FACILITY SITE NAME FACILITY CONTACT NAME <br /> C kv� A4viD FS S <br /> 1 FACILITY ADDRESS SI E PHONE R with AREA CODE <br /> 32 7 4F_ SI Za1� 9 Z Z' <br /> T CITY 'gr ST TE ZIp�E ft of TANKS <br /> Y - ' � < "- i cF74(2 at SITE 2 <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P <br /> P <br /> L <br /> I HAILING ADDRESS APPLICANT PHONE A WITH-AREA CODE <br /> C <br /> A <br /> N CITY STATE ZIP CODE TYPE of APPLICATION <br /> T CLOSURE, INSTALLATION, etc. <br /> A TOTAL <br /> C 1986 1987 1988 1989 1990 <br /> T ANNUAL FACILITY FEE (Prior to January 1, 1991) _ $100.00 loe i <br /> � Zoo /O� s ao1rMl <br /> E TANK FEE = $50.00/TANK (prior to January 1,1991P"y6140 5170/TANK (after January 1, 1991) l9Ad <br /> F A Tanks = �� ?) 1986 1987 1988 1989 1990 991 1992 1993 1994 1995 1996 <br /> A (multiply # by fee for <br /> 1 each year applicable) EV 60 54) SU ,00 6-78 s il. 2F <br /> L STATE SURCHARGE = $56.00 each TANK (Due every 5 years) See California H 8 S Code, Section 25287 <br /> I <br /> T Al Tanks x 556.00 1986 through 1990 1991 through 1996 <br /> Y (enter arnoun and year) <br /> 'm_rl neuca-in-Pl acel_ .___ _TANK J..D, #(a) <br /> LUCAS ELECTRIC <br /> 9976 HAZEL ROAD 1245 <br /> 8TOCKTON, CA 95212 <br /> BO 1D3 <br /> TO THE 19 1211 <br /> ORDEROF <br /> C <br /> BA KOFSTOCKTON - DOLLARS <br /> MID-STOCKTON OFFICE <br /> 240 N.San Joaquin Stockton,CA 5 02 <br /> FOR <br /> i <br /> i <br /> LMLCORSULTAT IONS VNnmnurtIccu ncccna c..,.$53.00/hr FEE = $53.00/hr FEE = 5 53.00/hr <br /> :::]::::::::::j <br /> TOTAL DUE S <br /> OFFICE USE ONLY <br /> ................................ ................ ............ .... .. <br /> .».»%...i:.w.».,.�...v».»%.».»w«... ...xo:%aemxe:xawezee:i»niie:>:::«efi.»rc«<S:.................................................. <br /> .............. __ <br /> M <br /> EET < 0{77'IS7 C'Of E Y OUN "RCG3 tkECK N/'C 15 i Y RVY° <br /> a C <br /> MIMMMYIYI.pM.IIMfIM,iM11MMIMMM%MMMM%OfN1MtW�' Ma"•%JfMAM%'(dtO:IW%f4YMW.P'O%t4b YtI AIY(O%f9.W'tl%NN%N 'MMMIMN.WM"'fy`�"••••••"••' <br /> Mia JIM•r nIi............__........Y <br /> pBY AV NNY%YY OaYM1IMnYtaW ANt#WS R%!mY%S.'+JCA$4i.TXM#s.......:d:,tY.':),W,._'M:^.�%>•.n,•....':�:.w; ::�.:.nE::'::::`Y L:�9�:::S::5t:yY S`rYAY `[„2N#Y NYb%YA'q'MNY�tlt AkYYQ%YC BN iiAfNyf4t/IY <br />