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S <br />'C <br />OBA F CA 2nQ PES <br />MAILING ADDRESS <br />1�8�o IqB� 1938 <br />1. Operating Permit Application/Annual Inspection Fee /75-D/ <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (/ 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 lI_ 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 9wner/operator has no intent <br />of re -using tank, 1 9D <br />(I I Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />1$I <br />I <br />Total Number of Tanks I Total Fee Due <br />2NOc-(tt to <br />Make all fees payable to San Joaquin Local Health District. <br />with your check - <br />SEMCO <br />TERRY HAMILTON, PRESIDENT <br />RICHARD C. HAMILTON, V.P. <br />PH. 219-524-9653 <br />431 W. HATCH ROAD --- <br />M DESTO, CA 95351 <br />Enclose this worksheet <br />1309 <br /> <br />PAY To <br />ORDER OF E _... V_V __ ...-f- �i�11N1�/.1 _ s <br />DOLLARS <br />UNION SAFE <br />DEDANK <br />D%A� NK � Q <br />PAYMENT <br />RECEIVED <br />SEP 19. 1988 <br />MUNMtNTAL HEALTH <br />PERMITISERVICES <br />*Both closures will be conditioned. Contact a Health District Representative. <br />Z -"G <br />