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fLL wORKSTILET PER LACII FACILITY <br /> FACILITY <br /> DBA SYoCk ycAi If'4 t'AL Cfil1 FTfh'/ ADDRESS ND aF r F rf CTf�'i/ �A7V E . Sroc%Y'aN ��• <br /> "ILING ADDRESS PD I?Cjy 1411 S %ec/rTaN C.1. __ 9i10 / <br /> 1 . Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ MO. <br /> b. Additional Tanks (I__ Additional Tanks x 150) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (156 x Total I 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 /> (I_ Temporary closures x $80) (See above i3 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 /> o/ re-using tank . PAYMENT <br /> RECEIVED qO - <br /> (11_ <br /> Permanent Closures x $90) <br /> 5. Plan Check Fee $30. AU G v 19a� <br /> j:NVIRONMENTAL HEALTFf <br /> PERMITISERVICES <br /> Total Number of Tanks r h'E Total Fee Due �/O• <br /> _---_ -. _--. _ -_. _ .. . . _. ..a,�_,e_. La..l..ea fhie vnrkthpat <br /> COLLEGE SQUARE OFFICE 7139 <br /> - P.O.BOX 688. STOCKTON,CA 95201 WELLS FAflGO BANK <br /> P.O.BOX 7237,CAPISTRANO BEACH,CA 92624-7237 STOCKTON, CA 95207 <br /> NORTH CAL P.O.BOX 214608,SACRAMENTO,CA 95821 <br /> CONSTRUCTION <br /> DATE 08/26/88 AMOUNT <br /> PAY Ninety Dollars 00/100 ,..O\.\:`:'C'`:"r',;:-'�;;-,'d;oo' ;;,r,'d:;;,'�':;::`-,;;\ $90.00 <br /> TO THE <br /> ORDER <br /> OF: San Joaquin Local Health District <br /> . - _ _ -• ,-\ . - <br />