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Wo(,3 rid F. Middle School <br />Ffi_ wORKSHEET PER EACH 'FAC! 10YI FACILITY 18500 L7 StxIpet I <br />CAI <br />L):;,Lodi Unified School District ADDRESS W1� y` 9525'8 <br />MAILING ADDRESS 815 West Lockeford' <br />�I <br />r A i , <br />w Facilit o dd'tion <br />� I <br />New Y <br />180. <br />First Tank $ . <br />a. I II <br />s�x <br />b. Additional Tanks__—d'dit iI ona1$50)' Tank I <br />2, Operating Permit Applicati,o;n/Annual Inspection Fee,''��' <br />a. Existing Facility and 1st Tank @ $150. <br />b. Additional Tanks (k Additional' Tanks x $50), <br />-state Surcharge (per tank)'(Due with Permit Appldicatioh, <br />on renewal or amendment of operat'iion permit and Itemporary closure) <br />($56 x Total k _ _ Tanks) <br />*Temporary Closure (,per Jrlder,ground,Storare'Tank in which' <br />storage has ceased but wh'ere,the owner/operator'proposes to, <br />re -use tank within .2 yearFs'. <br />( Temporary closures xl$80) ('See ahcve',3 t0 talc,ulate surcharge) <br />*Permanent Closure"(Ipertank) Uhde,rgrour+d Storage Tarnk in which <br />m <br />storage has ceased and where the owners/o,p,erator haslno'Iintent,! <br />of re -using tank within' n'e,xt,'2'years'.. <br />i <br />(p 1 Permanent Closures x'$g0) <br />90. <br />Total Fee Due <br />Ir <br />90. <br />f Tanks 1 <br />Num III <br />a Number o <br />1ot.. 1 <br />,I <br />�— <br />I ' 's <br />h,� <br />Encl.os t. <br />�1r're all fees payable to San ldoa u'in Locals: Health District- Enclose <br />� <br />worksheet <br />wo r <br />with your check. . <br />It <br />wit 4 . Tanks <br />it it 'w. <br />EXAMPLE -Annual Fee for, Fac Y <br />— Supreme,, �Gra,Ste of 1) <br />(1 regular, 1,unTeaded; 1 s,upr ,II $150 <br />la. Existing 'Pacility & lst Tank1150 <br />b. 3 Addit'ior)al ,'tanks x S50 224 <br />2, State Surcharge, 4 Tanks x $56 <br />Total Fee Due,I', $524 <br />l,' <br />Total Number.'of; 7a,nks <br />[loth closures will be conditioned. Contact a Health Dl strict Re resenta'tiv <br />2-86 I, <br />i <br />