Laserfiche WebLink
66A.. , <br />MAILING ADDRESS <br />FACILITY <br />4 ? nC) <br />I. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. <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 andtemporary closure) <br />($56 x Total I 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 />(/_ 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, <br />(/--L Permanent Closures x $90) <br />S. Plan Check Fee $30. <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 />7 <br />J. M. S. LEASES <br />PH. 636-2095 209-526-9871 <br />s <br />z. <br />umoML <br />10054 <br />_ <br />1602 SECOND STREET <br />ESCALON. CA 95320 <br />�zl <br />"'�-Y�}JJ <br />? <br />90-3677 <br />rte% 1211 <br />/ _ / <br />1 <br />PAY TO THE <br />` Z ��i/t�c{�.f�✓ <br />IC.G'� <br />ORDER OF <br />7 <br />DOLLARS <br />rent Valley Bank <br />iffiN <br />1925 TE BLVD. <br />MODEST0 ICALIFORNIA 95354 <br />i <br />/ l <br />