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1 <br /> MILIII f y� �� C4, <br /> WA, �`! �i /ilG B�?7�i�11 � ADDRESS X 30/ � Co koro(, 6 ict // <br /> MAILING ADDRESS / Lock E2ra -7-" (:q <br /> 1. operating Permit Application/Annual Inspection fee �l <br /> a. First Tank at Facility @ 5150. <br /> b. Additional Tanks (/ Additional Tanks x $50) x` 3 Cr?6, 7�) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit andtemporary closure) <br /> ($56 x Total /__ 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 f3 to calculate surcharge) <br /> 4. *Permanent Closur Ielper tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank; . — <br /> (/_ Permanent Closures x $90) / <br /> 5. Plan Check Fee $30. <br /> Total Fee Due <br /> Total Number of Tanks <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check, <br /> BANK OF STOCKTON <br /> w mcs r.usr <br /> <br /> CALIFORNIA CONTRACTON LICEN9C]0910]C-61,SA <br /> -T9020920858 <br /> !OB`B20 N.NNION . STOCKTON�CILLIF. <br /> gTOCKTCN,CALIF. 90101-0908 <br /> PHONE 309/16i6r1] <br /> � �� <br /> PAY- �w o �Uf J /%� ¢ /�J yC/ �t y- /0 0 DOLLARS <br /> DATE CHECK No. <br /> ro rNE <br /> ORDER <br /> STOCKTON SERVICE STATION EQUIP,CO.,INC. <br /> 'Both C1 — <br /> E — <br />