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' " no"�� i YtH LAW fAtll y <br /> `J <br /> 08A /94/- n76 -ADDRESS Y /DO <br /> MAILING ADDRESS P67. g e AQP 2-li7Ay <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P 1150, <br /> b. Additional Tanks (N Additional Tanks x $50) <br /> 2• State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 x Total M Tanks) ,/ <br /> 11 <br /> 3• 'Temporary Closure <br /> (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (# Temporary closures x $80) (See above /3 to calculate surcharge) /t///? <br /> 4• 'Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank , ' <br /> (M_S�_ Permanent Closures x $90) l B 21 0 <br /> S. Plan Check Fee $30. N <br /> k Total Number of Tanks 1.2 Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District- Enclose this worksheet <br /> with your check <br /> �'A y <br /> EXAMPLE - Annual Fee for Facility with 4 Tank, �, <br /> - H regular , I unleaded, 1 supreme, I waste oil ) MAR 1 FO <br /> r ` <br /> la . Extztinq Fai tliCy h 1St Tdnk 51511 <br /> h. 3 Add, t ,00,+ l Tank-, . S50 150 <br /> Z. State `mreharge, 4 Tanks r S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> uGT a i <br />