Laserfiche WebLink
0 <br /> 04 (UnrAj)t� loce2 " aooizEssT /DYS�c✓. ��CtJGyy . <br /> MAILING AOORESS 1�l W C� ��7• ��1 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $ISO. <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit andtemporary closure) <br /> ($56 x Total N 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 /3 to calculate surcharge) <br /> 4- *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the Qwner/operator has no intent <br /> of re-using tank, <br /> (1� Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Oue <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> Valley Commercial Bank <br /> 1067AAA TANK REMOVAL & DEMOLITION P.O.I <br /> ADA x97M <br /> PH. 209-369-4412 1031 East W-WH Road <br /> SwkWn,California 95208 <br /> 5407 E. MORSE ROAD /� <br /> LODI, CA 95240 / _ 0' <br /> (J 19V— <br /> I PAY DOLLARS $ <br /> TO <br /> THE <br /> ORDER 5�. <br /> OF �� <br />