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j • FACILITY // <- 1 <br /> � <br /> CA N �� ADDRESS `f U� -) . rn ltv►� �. 7S Z�f o <br /> AILING ADDRESS e7 <br /> Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 /> (S56 x Total M Tanks) <br />• *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 N3 to calculate surcharge) <br />• *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the 9wner/operator has no intent <br /> of re-using tank. <br /> (# Permanent Closures x $90) <br /> r. Plan Check Fee $30. <br /> n? <br /> U <br /> Total Number of Tanks ( Total Fee Due <br /> ake all fees payable to San Joaquin Local Health District. Enclose this P0AI iMVtN T <br /> RECEIVED <br /> ith your check . <br /> AUG 16 1988 <br /> ]ENVIRONMENTAL HEALTH <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks PERMIT/SERVICES <br /> THI$CHECK I6 DELIVERED FOR-EN I <br /> ON THE FOLLOWING ACCOUNTS. <br /> Pprmi M AND R COMPANY 33943 <br /> 33 E. TOKAY PH. 209-369-2725 AUG 1 6 1989 <br /> y �y LODI, CALIF; A 95240 <br /> t— a <br /> ZMa � <br /> PA OLLARS <br /> 6ZI To RDER -_ _ . <br /> U1m of <br /> 12 San Joaquin Local Health District <br /> A 1601 E. Hazelton <br /> L Stockton, Ca. 95211 J <br /> I <br />