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06A I ADDRESS C.c �` [fid Jt S t c� K�, <br /> 76) <br /> MATLING ADDRESS' ' <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ <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 /> ($56 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. <br /> (1' Temporary closures x $80) (See above 03 to. calculate surcharge) <br /> 4- *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the towner/operator hasno intent <br /> � � <br /> of re-using tank - RECeIVED ,�� <br /> (1� Permanent Closures x $90) ��`- <br /> «UV 4 1988 <br /> S. Plan Check 'Fee $30. <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> Total Number of Tanks <br /> -3 Total Fee Due �7 0 <br /> Make all fees payable to San Joa uin Local Health District. Enclose this worksheet <br /> with your check, <br /> DATE INVOICE AMVOUNT <br /> <br /> WESTERN METER SERVICE, INC. <br /> 2735 TEEPEE DR SUITE E <br /> STOCKTON, CA 95205 9 J <br /> (209)948-6124 <br /> F'AY C/ r D LARS i <br /> - TO THE ORDER OF GROSS AMOUNT - DISC... CHECK AMOUNT <br /> DATE <br /> OTHER ACCTS,PA ABLE <br /> WESTERN METER SERV 1NC. <br /> UNION SAFE DEPOSIT BANK <br /> STOCKTON,CALIFORNIA I <br /> J <br /> <br />