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FEE NORKSHLLT PER EACH FACILITY <br />DBA VanmA. RML I iQP 130116'. 0d ADDRESSY 11P 9 V� �' ` l� 1 K'-) <br />MAILING AbDRESS <br />1. Operating,Permit Application/Annual Inspection Fee <br />a. First'Tank at Facilitv @ $150. <br />b. Additional Tanks (d 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 />(b56 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 />(I_ 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 owner/operator has no intent <br />of re -using tank. 7 <br />( <br />(N� Permanent Closures x $90) n �� g � 9d D0 <br />5. Plan' Check Fee $30. <br />00 <br />Total Number of Tanks � Total Fee Due <br />D <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with, your check. <br />E% LANATION <br />SH 'S MAINTENANCE <br />1845 FULKERTH RD. <br />TURLOCK,CA 95380 <br />(2091668-8441 <br />.y <br />Y � 11 DOLLARS <br />I <br />/111NT 111 Y. I /l\ I �_ l <br />- <br />CHECK <br />DISC. <br />OTHER <br />NUMBER <br />TO THE ORDER OF <br />DATE <br />3CCTS.PAYABLE <br />F �L <br />GUARANTEE SAVINGS <br />2000 GEER RD. TURLOCK, CA 95380 <br /> <br /> <br /> <br />7971 <br />CHECK <br />AMOUNT <br />S� <br />CHECK VOIDIF NOT <br />/CASHED <br />/f WITHIN 30 DAYS <br /> <br />