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<br /> SAI,,�CAEOU I N LP- CAL HEALTH ,TR T CT
<br /> UNDERGROUND STOPAGE TANK PROGRAM - FEE VORKSHEET
<br /> f f FAC:!1TY/SITE NAME N ne �s FACILITY CONTACT HAKE
<br /> Raymond. Rishwain
<br /> `L�S""ET G9DD.ESS SITE PHONE I WITH ARL . CDDC
<br /> I
<br /> III
<br /> 18 N. Wilson Way none
<br /> CODE t of Tanks
<br /> Stockton, 2 at Site 1
<br /> A AP,aI ,ANrr rTrDl i APPLICANT CONTACT NAME
<br /> ,LLINJ NAME
<br /> P Roy 1. Weston, Inc. Erik A. Friedrich, R.E.P. , R.E.I
<br /> P
<br /> L WITH AP!A CODE
<br /> APPLICANT PHONE t
<br /> ;! 9" W. March Lane, Suite 12 209-476-1635
<br /> T-- ...- ---
<br /> +•ITS STATE IPC DETTYPI of APPLICATION
<br /> Stockton 5P2a7LDav c, IMB ALLATION, CTC. closure
<br /> ' T "' ! I
<br /> _E AD.�cSS per YEAR
<br /> :• n^' P - ---- - ---- -- - —TOTAL
<br /> �ITI
<br /> _ I
<br /> TIE (/oo C"'
<br /> E`TAhe FET .�n C,l) each TANK _ —_.._..._..._:
<br /> IF+� ?,..•.; _ t ,,0,00 1926 1997 j t92fl l 1?2�3
<br /> IAj (�el:;p?v by fee for
<br /> II =zch ve., a DIicahle) �'�- <'r� �C�_ _I Se> -� 1 s �U�• C�c7
<br /> �L'ISTATE
<br /> SURCHARGE = '56.00 each TANK (see CA HEALTH & SAFETY CODE Se: 25287 for applicability)
<br /> ` I ' Tanks Y 456.+111 1'?96 T- 1997 1lip 2 1929
<br /> r .e: er i1n, an• ,zr•
<br /> Y
<br /> N' u OSUP io l f r
<br /> I1,,E'���.I:.E,.T CL.�Jr,E (+';e,.lva. or .1osu e-in-pla'_e) i
<br /> LI
<br /> 0 CLnSW)c rcc _ s')0.00 each TAN', 90 . 00
<br /> --------------- __..
<br /> ROY F. WESTON, INC. 1417
<br /> i 83 W. MARCH LANE, SUITE 12
<br /> STOCKTON, CA 95207 �11-5i 605
<br /> (209) 476-1635 1210
<br /> t. PAY
<br /> . ITO THE
<br /> 0H1)EH0F APIA/_��.—�C� ��l /�•LTlY Z�EI�/Si_T>"9�/i� �7b•UO
<br /> -7-,Y SIX - -- ---—---- `7-----DOLLAR S
<br /> ..-�• Fire1 Imerslale Dank
<br /> of Cal:Wrnie A 695
<br /> 'n1erSf O1f_e 4932 Pacil,c Avenue
<br /> .a PO.Oo.7495
<br /> bank Stockton.CA 95207 f
<br /> FOR --
<br /> - 11'00 it, 7112 1: 12 n0^057 �:�Q502439611' L - -
<br /> ^'�
<br /> al"'�"'yllI!N .II'TrTmq"�°T!nl'�ppn -.!{r'nn q�'!I'i,,,pnl^!n ntl�•ni ne•F� �..,
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<br /> ��� Iktl:,�"�'I''i.'.t.�L�i:�.,.:,. ��,.,�Ln 1 7.1'Llfl,..l I< .!�Ill.a�1rIJ1.11.�wd1A•,NJ. .JII� 41� +p�lhl.,�l�'.'"t,..l. Jlu:�I�.I,J:a..l:�hl..,. 1a�uh a uhl..hh..�«l'111L, 6 n._6 cL.lbt.�l�.lhul.11a�
<br /> I�iSuEE^S ' I fOnP ^. ILO+: COOE� DIST CODE AMOUNT DUE AMOUNTctvt, CH.. t/CASH RCVD BY DATE RECEIVED PEPr:iT t
<br /> -----
<br /> 7
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