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AODRES S <br /> MAILING ADDRESS <br /> 1. Operating Permit Applicatiull/Annual inspection Fee <br /> a. First Tank at Facility $151. <br /> b. Additional Tanks (N = 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 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 /> (N Temporary closures x $80) (See above N3 to calculate surcharge) <br /> 4, *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owneerator has no intent <br /> of re-using tank , <br /> (N Permanent Closures x $90) OCT 2 �] - <br /> 5. Plan Check Fee $30. Lc,ir1 <br /> PEd7MlT/SERVICES <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check , <br /> DAIS INVC)ICU AMOUNT <br /> <br /> 2735 TEEPEE DR. SUITE E <br /> STOCKTON, CA 95205 3 <br /> 09 <br /> (209)948-5124 <br /> PAY 'Z DOLLARS <br /> GI7U55 AMOUNT <br /> - <br /> DATE TO THE ORDER OF - C7THER ACCTS.PA'rABLE DISCOUNT CHECK AMOUNT <br /> WESTERN METER SERV INC. <br /> UNION SAFE DEPOSIT BANK <br /> *Qo , STOCKTON, CALIFORNIA <br /> 2-8 <br />