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°�`!� ` ; t-✓ 4 C� TALI L l l l' <br /> lNG MOREAOORESS (( <br /> MA llSS <br /> .+r <br /> :I <br /> AApllcation/Mnuai inspection Fee O � <br /> >a�tA a. ;i►'SC'�:1'ank at 'FacilYtr P <br /> i150. MAY 2 7 we <br /> b Additional Tanks (/ Additional Tanks x 50 <br /> r 2- State•Surchar e • 5 ) .9NVIROMENTAL HEALTH <br /> 9 (per-tank) (Oue witA Permit Applicatioe;PERMIT/SERy10E$, . <br /> on renewal�or amendment of o <br /> I' peration permit <br /> (556 x •Total / Tanks) and te"ray closure) <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 /> Temporary closures x $80 , <br /> _ 4 "'Permanent Cloi ) (See above;/3 to calculate surch <br /> ure <br /> (Per tank) Underground Storage Tank in which fie) <br /> storage has ceased and where the owner(operator has no intent <br /> S 'of re-using `tank <br /> �N Permanent Closures x S90) <br /> S• Plan Check Fee S30. <br /> Total Number of Tanks <br /> Total Fee Due <br /> Hake all fees payable to San Joa uin <br /> With your check , q tocol Health District Enclose this worksheet <br /> f SAti�I r grtnu.t I F,!e fnr F' <br /> trility Witn .. Itrt , <br /> l I rrqui .lr . m lr.t lri <br /> li . ] Sill <br /> ,.Qr1 i t i and I l.tnt.'. $yn <br /> Stetr l')D <br /> Sir rC hd rrT" . 4 Idnkti <br /> -- SSI' 114 <br /> Intal Number of Tdnks 4 <br /> — Total fee Due 5514 <br /> 'both closures will be conditioned: <br /> Contact a 11 ' th 01strict R_epresentative <br /> -a6 <br />