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OBA c���tlJF , ADDRESS <br /> MAILING ADDRESS <br /> c <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Applications <br /> on renewal or amendment of operation permit and temporary closure) <br /> (156 x Total N_j_ 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 13 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. 1A <br /> RFq r <br /> (N, Permanent Closures x $90) s C MFN <br /> S. Plan Check Fee S30. Cpl LOOT <br /> Ptiy�F���198� 0ic� 1� � /l SCrC <br /> Total Number of Tanks LCSE9�� Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> St.Joseph's No. 44834 <br /> Hos itA „ <br /> p ,210(8) <br /> of Stockton ,oca> <br /> 1800 Nath C.t.f.t.,1.Soret SEPT. 20, 1988 <br /> St«kt.. CA 95204 - -. - - <br /> PAY EXACTLY 656 DOLLARS 00 CENTS !� I. ! ' t' moi/ ^"'I :�� ! II�;:I. $H ,S. _ .m„ 656.00 <br /> TO THE ST. JOSEPH'S HOSPITAL <br /> ORDER SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> OF P. 0. BOX 2009 GENERAL ACCOUNT <br /> STOCKTON, CA 95201 <br /> ,.. f... . <br /> MAIN OFFICE <br /> STCt.. <br /> 2-11.6 <br /> UGT a <br />