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WA - -- <br /> ,. � �" f.`i,; ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Applicatiu+I/Annual Inspection Fee <br /> a. First Tank at Faci l itv @ $151. � '}-- <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 /> ($56x Total K 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 /> (N Temporary closures x $80) (See above N3 to calculate surcharge) 4- <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 . ,: ' r <br /> (k Permanent Closures x $90) OCT 2 <br /> 5. Plan Check Fee $30. <br /> PERMIT/SERVICES Th <br /> t <br /> Total Number of Tanks Total Fee due [f <br /> Make all fees payable to San Joaquin Local Health District, Enclose this worksheet <br /> with your check , <br /> DATE INVOICE AMOUNT <br /> <br /> 2735 TEEPEE DR. SUITE E 9309 <br /> STOCKTON,CA 95205 <br /> (209)948-6124 <br /> PAY- Z2^- <br /> DOLLARS <br /> GROSS AMOUNT <br /> { <br /> DATE - TO THE ORDER OF OTHEa ACCTS.PAYABLE DISCOUNT CHECK AMOUNT <br /> 1 ��i�Tjii�T y <br /> WESTERN METER SERV NC. <br /> i <br /> UNION SAFE BANK <br /> STOCKTON,CALIFORNIACALIFO � <br /> `Bo <br /> 2-8 <br />