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JOA(IJM CCURTY Pt)5LIC REALTR SEMCES - <br /> - �v EMVIROFFaMAL REALIH DIVISION <br /> U4'OERCFJND STGRAGE TAKr: FN0GRA1t FEE 4;P.KSHE:T *ftr <br /> FACILITY SITE MARE FACILITY c*mTACT 9ME <br /> F59�w SerN S-r�,ol� }}nP.sx.b ��i� <br /> A <br /> C SITE PR.hE d mith AREA CODE <br /> I FACILITY A.ODRESS /��-9 -"I--� _ I-tp•7� <br /> �._._. STATE T <br /> I PCZ I o <br /> CITY ZIODE <br /> TAMX� <br /> _. 9s � a S,1 at SITE <br /> APPLICANT CCNTACT WE <br /> A AppucAMI%SILLING WE � <br /> P sjk5�i�'G/k GS 21c.k CGAUL..E <br /> P KC12U r-T N . T _ _ <br /> L r— ASPLICA 'T PHCNE A WN AREA CODE <br /> I 11ATLING ADOP.ESS <br /> I 133 Howe 4N/E 5u1T� x�Zd Lviw F"` <br /> A --T~ STATE 21P CODE TYP of APPLiCA•TION <br /> M C(TY�/�C11-l �FiIJ GlcZS,j ••Ocet <br /> -� — —�- - <br /> -"� ---^ � TOTAL <br /> 14e5 1457 1985 14e9 1940 <br /> A _ <br /> T�ACILIT( FEE (?rIv to JervVY 1, '1991' • 5100.00 t S <br /> V <br /> E TANK FEE = SS.;.0 /TASK (erior to lerssry 1,VM) 3176/itHK Eafter Jerluary 1, 11991) _ <br /> F f Tera <br /> _ ir39� T4£4 rl$SO :S4I 1S`7i j ''+'4i ( 1474 599; iSNS <br /> C oaeh Yrxr r (ieaDl e) - o <br /> I J5l L) <br /> STATE SVReMP.GE * `-`S6.00 ee.h TANK (Due every 5 ?:brsy Ses Lea!:n;ta Y, 3 5 Code, Sections on 2 ` <br /> ' 1956 (hrcuSh 1470 .551 through 1946 <br /> T TpnKs� X E55.00 (� om <br /> Y i (enter ar.>;:r:t srd Year) S 1 <br /> ?ERMANENT CL05L'Re (=enc•tl or At:Lhcrt 2CC Close I e-lo•P(oce) i TASX J. d(9) —- —_ <br /> C T r TAyK) Y Ti_tiX Cb) :( 51$9.110 x S <br /> L <br /> COME FEE = 143.(:0 per hour (3 hours .rtniava p" --- --,I <br /> S ! rHi i.^.alecticns) , <br /> U ?Er.:(.RA RY CLJSLUE i=1 or.c-tine permit, cr r _ <br /> � TASK I. ) <br /> R <br /> E FEE 5150.00 each TANK # rAiX(s ` <br /> E 00 <br /> TVPORR,2Y CLCSJi <br /> 1 P PUH I.NECK (lrstai t. Pl:r R[v',ev S :4trueticn i •e:.ee:�e^.a) i �iN s,::$y.: <br /> L i--- — --_ %R'o AMEN " ` <br /> A r hcur (() ':Cu:3 eln:resn par ra.tti:Y: - EN 4.o0 mir:trE+s S <br /> 4 P(AM UN- FEE 3.00 p" 'yam • .__ = ---"—�+�— <br /> ^—i,, re'+i;.. <br /> S 2-PAIR PEE (voripi_ :�`•�,'•, _ 1_____'__�•_ <br /> 'c �: N,ur ;} h.?� :.; ca,^i`+lm/TA.IK <br /> ? , TAHK FE?4;i FEE .3.;� ;"r -�- — <br /> Oir,f: Ger feci.:r/ ' =1:e.1.'; t <br /> a- _ <br /> R I PIPING REPAI4 EE ` per `•vr ^ a'° .� -- --"�ryyy <br /> - ~-T_i07r'C41.ED RELEASE <br /> 0� <br /> w tC�15Ul TA(iONS -j� "I(�1r1`L WIZ <br /> 5 —•—' FEE a 55..00i1•r I I FEE S 5?.JOitir - crtt'i'1 7i/JOO <br /> C <br /> TOTAL CUE S J <br /> CFFICS USE 01.LT \ revItSvJ� T,_'1� .... .. <br /> far>f kY 7 ac sm w .'.{•'•L: ,l � -� 6,:1 <br /> 0 <br /> EA 23 032 FRED 1/10/71: R <br />