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1 <br />OBA <br />MAILING ADDRES <br />FACILITY <br />1. Operating Permit Application/Annual Inspection Fee 44 P,eSS <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (M Additional Tanks x $50) <br />2. State Surcharge (per tank) (Due with Permit Application. <br />on renewal or amendment of operation permit and temporary closure) <br />($56 x Total K Tanks) <br />3. *Temporary Closure (per tank) Underground Storage Tank in which <br />storage has ceased but where the owner/operator proposes to <br />re -use tank within 2 years. <br />(#_ Temporary closures x $80) (See above C3 to calculate surcharge) <br />4. *Permanent Closure (per tank) Underground Storage Tank in which <br />storage has ceased and where the owner/operator has no intent <br />of re -using tank. <br />(a_ _ Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks <br />Total Fee Due <br />Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br />with vnllr rhPrk <br />=� �FCOUNTY OF SAN JOAQUIN <br />nocnoN. cAfooRN" <br />MANTECA-LATHROP RURAL FIRE <br />E D SPECIAL 33112 01 1****** <br />MVNBfR MAR 31 1988 <br />fUM(1 NO <br />..IF Or ISSUF <br />IM fnY..F a I— Jopyn Ceunl. <br />WILL PAY TO. <br />OR ORDER OF <br />S J CO LOCAL HEALTH <br />M4 WARRANT VOID SIM <br />.DRT K FRO" OATf Or IS U, <br />SrJ - <br />02324 <br />WAR$ NO K I <br />C k <br />1 12 21 <br />10 � I <br />PAY THIS AMOUNT <br />i <br />*Doth I (( ; <br />� 0f24324 wort R� I <br />2-H6 <br />1: L 2 1000 3 Sao: 0 L 544rFT1300 50u' <br />