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FEE NORKSHLEI PER EACH FACILITY <br />IMAILING ADDRESS x164 y .•. <br />1.' Operating Permit=Application/Annual Inspection Fee , - <br />a. First Tank at',Facility @ 5150,<. <br />b. Additional Tanks (/ Add itional`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 />(/-temporary—closures .x $80) ; (See above i3 to. calculate surchar <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 />(/--I Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks <br />Total Fee Due <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with your check,1-13 <br />�. <br />9 <br />0 <br />WESTERN METER SERVICE, INC. <br />2735 TEEPEE DR. SUITE E <br />STOCKTON,CA 95205 <br />(209)948-6124 <br />PAY_J <br />DATE TO THE ORDER OF <br />• -1711 <br />UNION SAFE DEPOSIT BANK <br />STOCKTON. CALIFORNIA <br />li'00903411' 1s 1 2 110 108 21: 5012545811.06 <br />90-108 <br />1211 <br />9034 <br />DISCOUNT -r CHECK AMOUNT <br />WESTERN METER SERVICE, INC. <br />