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WT-r <br /> rtL WURKSNLLI PER EACIi FACILITY <br /> FACILITY -, <br /> DDA &lI< ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Applicatiuu/Annual Inspection Fee 1 <br /> a. First Tank at Facility @ $150. <br /> I` o;` <br /> b. Additional Tanks (N ( -` Additional Tanks x $50) Y. <br /> 2• State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56x 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 /> (M_ Temporary closures x $80) (See above M3 to calculate surcharge) <br /> 4• 'Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank , <br /> (N_ Permanent Closures x $90) PAYMENT <br /> RECEIVED <br /> 5. Plan Check Fee $30. <br /> DEC 1 U 198;d <br /> ENVIRONMENTAL HEALTH <br /> Total Number of Tanks PERMITAgjy`Cr-e Due <br /> 4iMbii II BANK OF AMERICA <br /> LINCOLN VILLAGE BRANCH 0491 <br /> <br /> <br /> <br /> l LI CHECK NO. CHECK DATE VENDOR NO. <br /> ,COO N.UNION STOCKTON,CA 5S2O5 12[]91 462-5082 <br /> 2604 12'z cl9 <br /> CHECK UN7 <br /> IC��i•�/, a 5C� ''' <br /> TO THE <br /> TWO SIGNA EOUIRE EOR AMOUNTS OVER$1000.^ <br /> ORDER <br /> OF <br /> AUTHO IZ SIGNATURE <br /> I �.IVDVI I'D ryll , uC \.VIIUI LIVIICU. LVII LOL I. U flCtll Lll UI ] LI IlL f\111-]CIILQLIVC, <br /> 2-86 1 <br />