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�j. ' k��� § ��� �, ,' . , s � ''�, '�; �7 $ s pHr a find e�-� n� '• �+' ��" ^�k'�'�"'a <br />° �Per��tlg APettaia lippl iceti�,/ , ual�.;tn � f �tA�•�e.. <br />ha1.0 <br />ttrtank <br />�Mew 'r�r aloe � 1nt Of ' Operatioa��� L *� <br />%t permit. a <br />r{SSbQ e1'' / Tanks) nd f closure) <br />. . <br />3° "Tempora.ry Closure(per tank y <br />>Y ) Underground Storage Tangy yin which <br />st°rago`phas cease® but where the owner/operator'ro <br />re=use`tank within.2w p poses to <br />years... . <br />('t-- <br />Tem <br />Porary Closures x $80 <br />4• "Permanent Closure ) (See above /3 to calculate surcharge) <br />(per tank) Underground Storage Tank in which <br />storage has ceased and where the owner/operator has no intent <br />of re -using tank, r <br />(N Permanent Closures x $90) <br />5. Plan Check Fee 530. <br />Smleo <br />Total Number of Tanks <br />Total Fee Due ' <br />0 <br />3v <br />Make all fees payable to San Joaquin local Health wih Distrctvour._Ch,'ckEnclose this worksheet <br />WESTERN METER SERVICE, INC. DATE INVOICE A <br /> <br /> <br /> <br /> <br />(209) 948.6124 <br />8993 <br />PAY <br />