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Auk <br /> UNDERGROUND TANK <br /> BILLING STATEMENT <br /> CAMP ' TOTAL # OF ACTIVE TANKS <br /> AT SITE: <br /> SWEEPS: YEARLY FEES: <br /> ' FACILITY NAME: PERMIT ISSUED: <br /> FACILITYADDRESS <br /> BILLING ADDRESS: <br /> CITY: ZIP: <br /> TANK SIZE/CONTENTS DAVE "~ SURCHARGE N TANK DATE <br /> SURCHARGE D DUE T "REMOVED SURCHARGE <br /> DATE RELEASED <br /> j <br /> z <br /> i) <br /> biz <br /> #3 <br /> #4 <br /> 1 <br /> #5 <br /> z <br /> #6 <br /> #7 <br /> #8 <br /> #9 <br /> #10 <br /> Total State Surcharge Due: Pay this amount. <br /> Tank Fees: $100.00 per site 30.00 plan check <br /> 50.00 per tank 35.00 per hour inspection <br /> 56.00 State Surcharge 5 yrs 52.50 overtime inspections ' <br /> 90.00 closure fees per tank' <br /> State Surcharge due this year <br /> EH <br /> 23 0 10/89 ACCOUNT' RECORD <br />