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I <br /> a <br /> VORK�AEET <br /> you- k <br /> , <br /> a <br /> Po�. <br /> [, del B+ kides Petroleum Inc: 983 off t. 8 <br /> 9C}RES 2191 Na 'Dr. Ptoekton CA 9$2(}6 <br /> All mail must be sent to 2191 Navy Dr, St4clton, ;CA ' 95206 <br /> r <br /> 1. Operating Permit 'App!ication/Annual llnsp6ction Fee <br /> Ex9sting �'acility� and 1st Tank Q„x$150.' <br /> b. Additioralk Tar+ks '(# F Additional Tanks x $50, <br /> . 5tate'Surcharge {per tank} (bue with Permit Application, <br /> on renewal or amendment of operation ',pe it) i . <br /> ($555..2. Total - aks 3 <br /> . *Temporary cl ►su e ('per tank) Undo around Storage Tank in which <br /> storage has ceased but where the owner/opera�tor, proposes to <br /> reuse tank within years, <br /> { Temporary closures x '$8O} <br /> P . `an nt _Uos, re :(pea: tank) Underground Storage Tank h W,ich <br /> ;starae °has ceased: and where the had no intent <br /> of <br /> ng 'tank alit in next Zyears. <br /> Pe` anti dsurgs ,$9E7) <br /> a <br /> 2 <br /> Totalutahe ► Tanks Total Fee Due <br /> _ . <br /> k <br /> Dake all fees payable to AnJoaquin Local Health District: Enclose this worksheet <br /> with nui^ heck':a d the completed application'. <br /> z <br /> t [:E Annual Fee fair Fadi l i ty with Tanks <br /> M <br /> � . <br /> (1 re lar,' I unleaded 1 supreme, 1 waste��of1 } <br /> 5 <br /> 1 . <br /> -' 'Exist <br /> nFacility 1st Tan#c $2 . . <br /> t b. -Add~ titrnala Tanks` c $5p ' <br /> State surcharge; Tanks <br /> al ,1#omberof Tank : ' Te ak ;iFee �Dug. 5. <br /> i r. <br /> ' i. i,• .” <br /> bhkrs w11 `be cs .dttred.a : onot ealt,h Dtr� NT <br /> ct Re resentt» � <br /> .. .,.. ... .t <br /> v <br /> R <br /> Y <br /> k <br />