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DBA <br /> • aooisEss JJ(G l Co z ,'t Cid <br /> ILING ADDRESS 5 6 <br /> A, /OU fry <br /> 3-6S D S'6 <br /> operating Permit Application/Annual Inspection Fee 9 <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total M 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 t3 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 /> Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> /acl m acct, /D�6jC <br /> �w � 51 <br /> Total Fee Due <br /> Total Number of Tanks <br /> 5060a" Z-o n 7, <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check, <br /> <br /> <br /> �pp�MAIN <br /> osTocKTon,c uPonnu <br /> A!N EAl&UPP C0.A • 20892 <br /> CALIFORNIA CONTRACTOR LI CEN9CfiA`091059SE'1,SA <br /> CALIB O IN VNION ST..STOCKTON. <br /> P.O. 9O%500 STOCKTON, CALIF. 95201-OSOB <br /> PNONE t09I�•'�15 <br /> po DOLLARS .. <br /> �, cc <br /> PAY DATE CHECK NO. <br /> <LOS <br /> eaL�h _ tb 11-Ss�s '2GS92 3Gb . <br /> TO THE �0 �1`l�- ,�„`1�yr �t S�•_�s3 <br /> ORDER 01` `L 1 STOCKTON SERVICE STATION EQUIP.CO.,INC. <br /> <br /> UGT a I _ <br />