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DBAr <br /> ll „uL 11 <br /> �1C�b� e .n �A� nem ADDRESS o� 1a0 (� 1`` �y.4 11 /1 <br /> a� <br /> MAILING A' DDOSS ' , > � ,� ,x LL L �• :-tir: <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First TaWat Facility @ $150. <br /> 1. b Ad.ditionai Tanks (4 Additional Tanks' x $50) <br /> 2• 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 (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 ,380) (See above /3 to calculate surcharge) <br /> "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank. <br /> (lPermanent Closures x $90) 1°AYMEN7' 9d <br /> 5. Plan Check Fee $30. RECEIVEL) <br /> JUL 13 1988 <br /> ENVIRONMENTAL HF-ALTNotal Fee Due <br /> Total Number of Tanks / PERMIT/SERVICES ��� <br /> Make all fees payable to San Joaquin Local Health District, Enclose this worksheet <br /> with your check. <br /> SEMCO 12651 <br /> EXAMPLE - Ar TERRY HAMILTON, PRESIDENT <br /> RICHARD C. HAMILTON, V.P. <br /> PH. 2p9-524-9653 <br /> 431 W. HATCH ROAD -19 go-1 <br /> 1 MOD*GA1PAY TG TME _.OQ• Oa <br /> --- -__-- _DOL L A RS <br /> N <br /> CENTER STATE BAK <br /> T 4600 BROADWAY -__--- <br /> O SAL.IDA, CALIFORNIA 95368 <br /> all <br />*Roth tlo'sures vw,....- <br /> 2-HG _ - <br />