Laserfiche WebLink
E WOMS1W, <br /> tie 014 hs V% I <br /> WA <br /> ADDRESS <br /> K <br /> � � k <br /> 1. Q rati Pe it pIi tion/ . n 1 Inspection Fee <br /> a. -Jst lankX3150. 1 <br /> a W iti l ins t Additional Tanks x $50) <br /> ---,,2. State rc r k) with Permit Application, <br /> 1r nt o ration it) da p®,o® <br /> x '#ts l ` Tanks <br /> J. .*Temporary" r tank,) erground Storage Tank in which <br /> storage s ` a t ere the owner/operator proposes to <br /> -use n :w, in 2 years. <br /> 'Tracy closures x $80) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> s rage st' sed and ere the owner/operator has no intent <br /> ofJ re-usingtankr1within ext 2 years. <br /> �f -- Permanent Closures x $90) <br /> 63®. o® <br /> TotalNumber, Tanks, Total Fee Due <br /> -` all Y quin Local Health District. Enclose this worksheet <br /> Iication. <br /> . <br /> R r" • <br /> , .. 1 , <br /> with 4 "tanks <br /> ¢ � sup.• s 1 s oil) <br /> .-T $150 <br /> 150 <br /> 7 . <br /> :z r 2 .d �. r° �3�• <br /> s <br /> x 224 <br /> p � <br /> 6 <br /> Total Fee Due $524 <br /> k <br /> ♦ i <br /> + OtT�' 1 uru hill :i t it a Health District Re resentative. <br /> ° <br /> a f" <br /> h f <br />