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14A <br /> �'�c <br /> ` . <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> S' a. First Tank at Facility P 1150. <br /> b. Additional Tanks (If Additional Tanks x 450) <br /> 2. State Surcharge (per tank) (Due with Permit Application <br /> on renewal or amendment of operation permit and temporary closure) <br /> MIS x Total M 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. F/ <br /> Temporary closures x 180) (See above 13 to calculate surcharge) <br /> i; 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 190) jb.9 41 <br /> Y <br /> S. Plan Check Fee 530. <br /> 7A t <br /> ,{ A , <br /> F Vy� �lyoa O E Qa /2 l�eclif <br /> Total Number of Tanks /��r9! Total Fee Due <br /> - — F,pL/cF,ylglrti <br /> - Make all fees payable to San Joaquin Local Health District, Enclose this worksheet <br /> with your check <br /> BANS cOF SS OCKTON <br /> <br /> <br /> a��.1/z�/q/yy/�/�Y �I�pRp q�/� yy� coProcnron,CAYlowm• <br /> a,/y.M�0YM1�iY0Y ,low.pWlhM <br /> CALIFORNIA CONTRACTOR UC.-C <br /> SSO N.UNION ST..SOCKON,C ]M <br /> P.O. SM 09108 C-6 <br /> 1SN 19 9 9 4 <br /> PNKSE SM�261-8,21 C5/ <br /> PAY ^Y' zEEST; o o RS <br /> DATE CHECK NO. <br /> TO THE C �L_ ll\`1.c.o01AV, 1\Q o_1.fh 1)trtcV <br /> I ORDER OF JQh 1 <br /> STOCKTON SERVICE STATION EQUIP.CO., INC. <br /> I <br /> .J.»---- ..----- -- _ <br />