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FACILITY <br />)BA AY.� ,n.roc U A00RFS S t �'✓� <br /> IATUNG ADDRESS /oQ - <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $151. <br /> b. Additional Tanks (1 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 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 /> (! Temporary closures x $80) (See above #3 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 . Q ' <br /> (I 2-/Permanent Closures x $90) <br /> 5. Plan Check Fee S30. <br /> Total Number of Tanks 07— <br /> Total Fee flue <br /> rasa, j <br /> Make all fees payable to San Joaquin Local health District. Enclose thisWo <br /> rkshee <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> —jI � .. ...__ <br /> a sEMCO 1328 <br /> TERRY HAMILTON, PRESIDENT <br /> RICHARD C. HAMILTON, V.P. / Q <br /> PAL PH. 209-524-96153 9Q-1314/1211 <br /> 431ATCH ROAD <br /> MODO, CA 9rai51 - ee�� yf'^� <br /> PAY TO THE!_0' <br /> ,p /O dv <br /> ORDER OF <br /> Lt AR5 <br /> UNION SAFE <br /> DEPOSIT <br /> ms�`Both closu DANKff}} BosEw.Y.Sailtle,CAL �Y <br />