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FEE WORK-SHCET PER EACH FACILITY• <br /> D8A10 <br /> FACILITY I I <br /> ADDRESS' f3rJp Ndlnl`� I� 0 � htCA <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (M Additional Tanks x $50) <br /> Z• State Surcharge (per tank) (Due with Permit Application. <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total N Tanks) <br /> 3• "Temporary Closure <br /> (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 /> (1_ 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 gwner/operator has no intent <br /> of re-using tank . <br /> Permanent Closures x $90) PAYMENT <br /> 5. Plan Check Fee $30. RECEIVED <br /> NOV 1 u 198r <br /> Total Number of Tanks ENVIRONMENTAL HEALTH <br /> PERMITAMICE&e Due 0770. o <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br /> with your check . <br /> SEMCO <br /> TERRY HAMILTON, PRESIDENT 1343 <br /> ifs, <br /> RICHARD C. HAMILTON, V.P. I <br /> PH. 209-524-9653 (� <br /> 431 W. HATCH ROAD �� '19 rp 90-1314/1211 <br /> ODESTO, CA 95351 MV <br /> N,w tai iiu � IL.Y¢r"1 <br /> �hlel ✓ Q�� ✓ ��l',� �e2r� ;�70 <br /> UNION SAFE D 0s <br /> 1. n 1 4, <br /> DEPOSIT 1� <br /> DANK <br /> WO <br /> lIl <br /> o ameo.,.v.saeMW ��4 y <br /> a�,ca n <br /> ve. <br /> ICS � 1 <br />