Laserfiche WebLink
�• by .,, , <br /> ROUND STORAGE TANK PROGRAM — FEE NORKSi.-- <br /> F FACILIIY/SITE NAME . fAClLJTY CONTACT NAME <br /> A <br /> I Ji <br /> L STREET ADDRESS SITE PNONE 1 (vith Area Code) <br /> Y CITY STATE 1TP CODE 1 of TANK'S ` <br /> TD/t� at Site <br /> P APPL1CANi/BILLING NAME APPLICANT CONTACT NAME j <br /> P <br /> L ry '1 <br /> I flAll(HG ADDRESS APPLICANT PHONE I (vith Area Code) <br /> A <br /> N CITY STATE IIP CODE TYPE of APPLICATION <br /> T (Closure, Installation, etc.) <br /> :S <br /> r <br /> EIE FEE _ $100,00 each SITE ADDRESS per YEAR TOTAL 's <br /> 1496 1987 "1988 1983 <br /> = 950.00 each TANK <br /> x $50.00 1986 1987Ii88 1139il'by fee forar applicable! /� L�pv RCHARGE _ 156,00 each TANK (see CA HEALTH i SAFETY CODE Sec .5287 for applicability) <br /> T t Tanks x 156.00 1986 1987 > 1988 1989 <br /> Y (enter mount and year) <br /> S <br /> C PERMANENT CLOSURE (Reeoval or Closure-in-place) - <br /> L <br /> Q CLOSURE FEE = 930 00 each TANK I Tanksx $90.40 $ fG <br /> r �`�, <br /> PD!l 0 MAIN Gr/.IC! 11-3511210 <br /> lr� � � \ ��xv F` \ _ � •v J/� `�_� ^ =pANK OP AMBRIGA o ,; <br /> - \F 'E�� 1T st`• 7 5 'r/�`.: \t -� '� / 4 AOR f�i Moa!!1'(o RANos <br /> V t ��1 Ap r KEN . <br /> y� moi' �f I208);5x49853 ` 4 til/ Q C 7 — ; <br /> 1." <y, r`s ;f� ��' c`�r'`x �,4.a��.3�a.�,�s?' �.}�,.b" � {a tf �yh < •� a tcv` ' '\ � :!.. .� <br /> iY,�y y�� pt`',�*� �` �a \.- � I a� x Yl " �i .z�Zti�T\. },ftiV�`, �� T a ar'-- y✓ �. � � .. <br /> r ,: oAT6 CHECK HO, AirldUNT <br /> i� L { R a r r <br /> \ �\ -• \ \�,� � \� ,,���f - �\_ kr �` _h J ' III <br /> S - ' - <br /> Ila <br />•^ev yiF�e ',t ^./ y7. 6, ,� Tl f! Y: T � y 3 i Oytr.+,r :. <br /> SWEEPS I COMP 1 LOC CODE DIST CODE AMOUNT DUE MOUNT RCD, CHECK 91CAS11 RCVO BY DATE kECEIVE0 PERMIT 1 ;! <br /> aY�y Gv�viovyo� Ci. 3.2,3la 9z 7 <br />