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J6 i <br />MAILING ADDRESS ADDRESS y <br />Operating Pe <br />unit Application/Annual <br />a First Tank at Facilitv @ $ISO <br />b• AdditionalInspection Fee <br />s <br />2, State Surcharge <br />(y ' <br />urcharge (Per Additional Tanks <br />on renewal tank) (Due with Pe x $50) <br />($56x T °r amendment Of operation Permit Application <br />To 1 <br />Tanks) permit — <br />3, "Temporary Closure and temporary closure <br />storage (Per tank) Underground ) <br />age has ceased but where the Storage 9e rank in which - <br />e tank within 2 owner/operator -� <br />Tem years, in <br />to <br />4• 'Pe POrary closures x $80) <br />Permanent Closure (per (See above y3 <br />Stora tank) Under to calculate surcharge) <br />9e has ceased and ground Stora <br />Of r _ where the ge Tank in which <br />re -using tank °wner/Operator has <br />no intent <br />(y—L Permanent Closures x b90) <br />S• Plan Check Fee $30, <br />Total Number of Tanks <br />Total Fee Due {. <br />ike all fees1� <br />Payable to San Joa <br />th your c; — --___ 1 n local Health Di <br />strict, Enclose this worksheet <br />SAN JOA <br />QVA-- - <br />XP.G. & E. CO. o. LLEY REGION — - EXAMPLE REGIONAL PETTY CASH FUND — <br />� �E 1401 FUL70N <br />„ FRESNO, CA <br />7941 <br />�" <br />�i 37fi0 � <br />0� � <br />o der o <br />Bank of America v 0 tIn '� <br />6]2 lice 0010 <br />Ffe�b. CA 93717 /��`AY'➢n.�.._. <br />h cl <br />will be condi <br />tioned, Contact a Health District 'e resentative, <br />