Laserfiche WebLink
SAN JOAQUIN LOCAL HEALTH D ' STRICT <br /> )NDERGROUND STORAGE TANK PROGRAM - FEE IIORKa. .:T <br /> 'h FACILITY/SITE N� /; )' C> FACILITY ONTACT NAME - — <br /> I.....--- — ---..._.. __ _ --- -- __ _. <br /> Ao- <br /> L <br /> STP,EET='DERE ITE PHONE 1R WITH AREA CODE <br /> TDD <br /> Y CITY SJJITE� IIP CODE�t of Tanks <br /> " / (� �t( 2.�lp at Site <br /> __......................__...._...---�_.—.__...._....._._.___ _....__.__ ._._._____._._.__----.-__-._.______- _-.•- __ __ _ <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME — -- _ <br /> P �� n <br /> APPLICANT PHO E 1 WITH AREA CODE <br /> cc <br /> STATE ZIP CODE TYPE of APPLICATION -- <br /> 'v O CLOSURE. INSTALLATION. ETC. <br /> CD EAP, TOTAL <br /> CD cu <br /> CD ��,. 1981 1988 1989 <br /> F <br /> ` Cc <br /> 1987 1988 <br /> UJ 1989 <br /> 0 TH & SAFETY CODE Sec 25287 for applicability) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> (when applicable) <br /> _ .............._........_....-_._..............._....--»......_...__...._..............._..._.._.._._....—___.... -- _ .—_.._............_.................._.. <br /> w - FEE $3' 01h t t <br /> -............._................................ <br /> .._..__....__._._.._.....................__.___ _..._..__._....____ ----- __._._._ . <br /> Ir <br /> C o , 0 TOTAL DUE <br /> O <br /> II o O <br /> z y _'� !SIN,rIINN9Ni�NNnl91!iINN1111'il1111!�71111311[1011"S.1I1i I!IIiN 11111!N!1!'iNif 01 .11!1!nIINN�N�NIINiIFiIINIIINn RIIIN 0110 T1111 <br /> U r-O a i 4... i r <br /> W c °Cr AMOUNT RCVD CHECK, I/CASH RCVD BY DATE RECEIVED PERMIT I <br /> ._._................__.__.....__..... ........... <br /> ti ea ao z �ll.c l..... ryl ......_......_ -Z�_ <br /> 1'11Nfi':111NIINNNINI IiIIN111 19Ni11P11111NG111111NIN!1NN111N m""°°111N11i9NN�1!II. IN�I�ININIIINN111111NN111NN!N ,1111NNPIOPRU1 ,a� <br /> I �: <br />