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FACILIIY dot <br /> D$A , j J ADDRESS <br /> MAILING ADDRESS r a4"-ne � <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First "tank at Facility @ $150. d013 <br /> b. Additional Tanks (0 _ Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Applications <br /> on renewal or amendment of operation permit and- temporary closure) <br /> 056 x Total # Tanks) <br /> 3. *Temporary Closure (per tank) Underground Storage Yank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (/ Temporary closures x $80) (See above 13 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 Ot F.CEIV ED -Lg� <br /> (1 -'ermanent Closures x $90) <br /> � <br /> 5. Plan Check Fee $30. <br /> NOV 4 198 <br /> ENVIRONMENTAC HEALTH <br /> RERMITISERVICES c3� <br /> Total Number of Tanks I Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> >I <br /> 9290 <br /> CASECO AUTOMOTIVE <br /> 1025 E. PARK 948-0465 0 <br /> STOCKTON, CALIF. 95205 _19 90-10&11211 <br /> D <br /> PAY TO THE J f] W <br /> w <br /> DQ!_ LARS <br /> UNION SAFE <br /> DEPOSIT <br /> DANK <br /> 1340 N.El DoradoPr 510 kl—.CA 85202 <br /> MEMO �to t i Ve r <br /> - 1: 12 L L0 1O1121:9 290,11 20 2770 11'0 1 <br />