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f SAH JC�Aaj,W CGUH4T p1JBlIC HEALTH SERVICES <br /> ENVIRONMtH;AL NEkt1H DIVIIION 11tET <br /> UNDERGROUND S1ORAGC ANK ,PROGRAM <br /> FACILITY CONTACT NAA1E <br /> FACILITY SITE NAME <br /> A 'PITT-DES �k)INES INC- (PDM) 5� 5°N '�W AREA <br /> I:ota9 <br /> �„'WRTLE� F x <br /> t l <br /> ATI <br /> ataSITENKS THREE (3) <br /> T <br /> y�UCKTON APPLICANT CONTACT NAME <br /> A APPLICANT/BILLING NAME PANI)Y KEARNS <br /> P PITT-DES It IVES, INC, PHONE <br /> P (2�9) T 74 a �z 13 WITH AREA COD! <br /> L \ lJ / <br /> ,'"` ADO�oxR D TATE Z�Q�F tEj TYPE of APPLICATION <br /> A �� `� CLOSURE INSTALLATION, fEC. CLOSURE <br /> j `-I+R KT1N l TOTAL <br /> 1986 1967 1968 1989 199 <br /> 0 <br /> As ;100.00 _ <br /> C <br /> T ANNUAL fACIL{TY FEE (Prior to Jarwery 1. 1991) 1 1991) <br /> 1 1,1991) 5170/TANK (after January r <br /> 550.00/TAHK (prior to January 1994 1995 1496 <br /> € <br /> TANK F€€ 1909 1990 1991 1492 19ir3 <br /> 1986 1997 1988 ; <br /> F >Y Tankfl* fee for <br /> A (tTulttp Y ltcable) Section 25267 <br /> i <br /> C •ach year app <br /> L STATE SVRC1tAR0! + •5G,99 aMrh TANK (Duo eylrY 5 Years) Sea California H 6 5 Code, <br /> 1491 through 1996 <br /> 1x 556.00 1986 through 1490 s <br /> T R Tenkr ear) <br /> r (enter emovtt and Y <br /> 11D 8073 <br /> BANK OF STOCKTON <br /> HEADQUARTERS <br /> STOCKTON. CA 95202 <br /> •t[ocuT[s 90-103-1211 <br /> IM P[ATM[RtMIF Vw Zµ[LlMMI'INY[MT <br /> p.0.9ox 1257 <br /> STOMTW CA 95201 <br /> ** ty-Seven Dollars and No Cents* <br /> aur Hundred Seven <br /> FWOUNT <br /> DATE *; 00* <br /> 1/29/92 <br /> PAY San Joaquin County . TWO SIGNATURES REQUIRED OVER $500.00 <br /> TO THE <br /> ORDER <br /> OF <br /> I <br /> Il <br /> _ TOTAL DUE s <br /> ii:iii ilii iiiiie ii::1;::ii:iIu iwi wwe Iw[[M <br /> OFFICE USE ONLY . ��» k 1 � <br /> Rt <br /> .............. <br /> ■^ r <br /> M. wM,MlM.Nf 11MN�Mf..n1.Mq INNS <br /> » 1 y7 n uw <br /> r t O �'" ON fIWM r♦ii ilYl IIM[M IIiM Mit MTM I[o Mi <br /> ••1w/N.MI W sw�r w <br /> wa■iiw MM fll/MN MMr ....,. MNt ';''A..... .......... ... <br /> .wn MM <br /> Z. <br /> rM1 Mn»MM -MMMT 11x1 r <br /> �..�. � ..7. ..� .,...�yr�.w�»i� �Mei[MIN 1 M MMM fMf MMM rM MNM MIf!MY MI�1f lIM1� <br /> a w w Mw MIMN MN MNw """"~ Plot 11 <br /> €11 23 032 (REV 413/91) ft <br />