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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> UNDERGROUND STORAGE TANK PROGRAM - FEE WORKSHEET <br /> Y/SITES NNAAMME/� FACILITY CONTACT NAME <br /> ADDRESS SITE PHONE I WITH AREA COOK <br /> _ STATE ZIP CODE 1 of Tanks <br /> 411aT-Iv7e0P <br /> _ at Site - - / <br /> NT/BILLING NAME APPLICANT CONTACT NAME <br /> S <br /> ADDRESS APPLICANT PHONE I WITH ARIA COO! <br /> ---=SX7 --— 0 D - —Z —_ <br /> STATE Z CODE TY PPLICATION <br /> �r�•[L///, _-----_�� 33.{� OYR[, IMETALLAT ION. ITC. <br /> Y FEE _ $100.00 each SITE ADDRESS per YEAR TOTAL <br /> —-------- — -._... <br /> .__/0 <br /> 9U-- --... /OyU $ — <br /> ZO V <br /> E _ $50.00 each TANK <br /> SO f <br /> _ x (50.00 I 1988 <br /> .............._ <br /> 1986 / 1989 <br /> Ty I by fee for --- — <br /> ear applicable) �--U <br /> 'URCHARGE =—$56.00 each TANK (see CA HEALTH 6 SAFETY CODE Sec 25287 for applicability) <br /> x $56,00 1986 1987 1988 1989 <br /> Z ��— <br /> NT CLOSURE (Removal or Closure-in-place) — <br /> FFF Tanks —- x $9.0_.00 <br />.[IELIVEflEG IN � -- <br /> LLOWING ACCOUNT(S) <br /> SAWMAKER, INC. 679 <br /> 16177 SOUTH MC KINLEY AVE. 983-0608 <br /> LATHROP, CA 95330 <br /> _ 90-3298 <br /> CES =S -/�i 19�3C/ 1211 <br /> UNT [[i�,, —•�-- <br /> PAY TO <br /> ORDER OFEcaN/✓ �qQ // ,L Q.. <br /> NS <br /> .yL�i rti I $ 171'�46� _ <br /> ECK L�l <br /> DOLLARS <br /> IaNationai 611 North Main Street i <br /> ank Manteca, California 95336 <br /> USE ONLY TOTAL DUE <br />'tl I�I�tl9111!�IpPlWltlu. IAtltl9tli�l�Jl � .I tl��tl8lpRtll�Gtl.�i I��I�� .��I�Vtl�utltl!�III!�� �tltl�tl6�0�1�1�@W!Itl�ltl�i !I�ItltlItlCIV4lPufiliVtl&tltl�Mtl2AtlVI��IVtlI�V'tl�plNl�Vtlfdl�lil�IItl191�itl19AiIP�tlq.�f <br /> COMP 1 LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK. WASH RCVD DY DATE RECEIVED PERMIT 1 <br /> yg gg a�.... y�v * --..... d_ �o�1 ....._ . ,- aft---_--— <br /> FI ��tllrlvl'p 11'14I�II�V IG Ill�ml �!IltltltlVPltli tlitl�tlUM�tl�ItlOnitll!itlWl�il�tlV! Itll mtlVIIPoI tlJtlil 9V9BGII�IIIItlVItlNV'OtllwGGoIlRVV!NI iff,MV7 <br />