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ARKSKE14MEACH fACILIZY.
<br /> ADORE
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<br /> Opp rad ; tpPl IC-4tioaj rinual tnspectton fee
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<br /> ti i a 7 'A+t 1f act t ty:
<br /> 6 Q i a Auks .'���L=' Mdltional Tanks x
<br />'State,Sua (per, tank}(Due with Permit Application.
<br /> � +,L t♦f J=a3 t i a-
<br /> on= renes al"KKo'r t�aisieridment>of operation permit and temporary closure)
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<br /> Ayqdle � kUnerground Storage
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<br /> xempor, 'a��sr�i�HfsfiTs�1x)1:'J,k-,l-ti.f'bi�r ti' '}'��Kr.J �k y7 �l!MI�A_+„•n +x..
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<br /> sre-use; apt this r ears: -` ; _`_. � � . � y„
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<br />�1► r sig 8o a Sitio� al a aft u�ha a-Penaan p ourx' e nk ” erground Stortn,�rh ct� ,` �
<br /> fora a ,ceksed� e�x y ryope ato s`"no'�
<br /> x�i0�„•t �ryRtS n �,�', r �.�,�K ;� �i��yL T '(.4,f r +j�;•i+Yh}f'i� .�''%�. I:t;i' e1:� Y ?�� i n. �� y, �(�'1✓�`�
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<br /> .�T�, ^, sd �i I ri�f 3'a� + a�; �) `• + 14' "�` `.'tZ a „� i t `a ja,ti,"n 'Y� �,,;�, ,'���w�t .
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<br /> '_' � � fa .'�t {T� Is^•tie:
<br /> 1T:fees'payable to-tan `Joaquin Local Health'District. Enclose this rrorksfieet
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<br /> :h your check',
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<br /> r Tanks : AYE
<br /> EXAMPLEWAnnual Fee,for F�1 i ty eai th �s }
<br /> reguia%r; lku?�leaded;il.supreme. '`�i waste oily <�
<br /> ` $ISO JUL ,
<br /> ' la. Existing Fac'
<br /> 1st Tanks .20198
<br /> • ' ; bt 3 Additional Tanks x $50 15 �1p p �
<br /> . ,2. State Surcharge, 4 Tanks x SS6 724 JCd
<br /> �M1T HE,q�
<br /> ��l 'Yt •Y' ', , �' c t • c ..
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<br /> 1 �, , . , Total Fee
<br /> ode 4 $524
<br /> iota �f�umber of Tanks 4 �
<br /> #, {� , !� .A� f tet• � ! �� . ` LiC F a�� ��..+ �,' �� `�
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<br /> closures, t'11be coed tinned. Contact 4"e lth District R�yn� tative�, .
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<br /> �aaT t �i d `� �►¢rrn�.+ td rt,�.'►' `.x; r.i i "`i +�� + fit�`
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