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rLL "utik��%Lti VLK LAW FAC1L11 <br /> DBA IDLY-WILD FACT L I TY 3049 W. div 12 <br /> ADDRESS <br /> MAILING ADDRESS 3049 W. Hwy 12' Lodi, CA, 95242 <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (I 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 /> ((_ Temporary closures x $80) (See above #3 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 /> (1 1 Permanent Closures x $90) �P90.00 <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due l 9e- a0 <br /> Make all fees payable to San Joaquin Local Health District. 'Enclose this worksheet <br /> with your check. <br /> ,. X71 <br /> IDLEWILD MOBILE PARK 695 rl <br /> 3049 W. HWY. 12 389-1132 <br /> 1 <br /> LODI, CA 95240 0-46920 90-844 �, } <br /> J` [21 ! <br /> PORDER Of aln <br /> AY fU 1FiL/+ 111 '�1+�I-__C_/ $ O. <br /> 0-_ _ o L L A R S .� <br /> -M <br /> 0' ad O*lC[ <br /> FARMERS& <br /> MERCHANTS 4 <br /> AL F <br /> III DANK CoRNA <br /> I[I IYWI HML LU➢I,cwueyyp <br /> <br /> <br /> <br /> �� i;l Motive. <br /> EH 23 032 2/86 <br />