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�r <br /> DBA ADDRESS d <br /> NAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee � fS <br /> a. First Tank at Facility @ $150. { <br /> b. Additional Tanks (f� Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, ?o)jon renewal or amendment of operation permit and. temporary clo O(S56 x Total f� Tanks) C —lam <br /> 3. `Temporary Closure (per tank) Underground Storage Tank 1n which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (f_ Temporary closures x $80) (See above f3 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, PAYMENT ' <br /> RECEIVED �D <br /> (f__L Permanent Closures x $90) <br /> 5. Plan Check Fee $30. NOV 4 1988 �— <br /> ENVIRONMENTAL HEAL114 <br /> PERMITISERVICES 3 <br /> Total Number of Tanks <br /> Total Fee Due <br /> lx�lgy �'7 i / / D u/r��ocal <br /> ba cl' Fees an -/1" � F� /V / �7� �� <br /> Make all fees payable to San Joaquin Health District. Enclose this a 3 sheet'P90 <br /> with your check. ASO �oslc� <br /> VIC <br /> BANK OF AMERICA <br /> LINCOLN VILLAGE BRANCH 0491 0023 <br /> 56 <br /> P.0. <br /> III O. 9 BOA <br /> STO <br /> I CKTON, CA 95201 <br /> HIM I1 H I 1. 1 CHECK NO. "CHECK.DATE VENDOR NQ <br /> loon r�.urwoN STOCKTIX .CA 9, 12 j asz-soe2 <br /> 2356 11/4/88 <br /> PAY #####NINETY AND 00/100* '"#" <br /> CHECK AMOUNT <br /> 890. 00 <br /> TO THE 51 RE E D FOR AMOUNTS ER(1000. <br /> ORDER <br /> OF San Joaquin County Healtn Dri <br /> AUTHORIZED SIONAT <br /> - v <br />