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AUUHt�N <br /> MAILING AOORESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P Sly). <br /> b. Additional Tanks (/ Additional Tanks x 150) <br /> 2. State Surcharqe (per tank) (Due with Permit Application. <br /> PA on renewal or amendment of operation permit and temporary c1o1PrYEf,M ,T <br /> ( x Total I Tanks) D <br /> S56 <br /> 3. 'Temporary Closure (per tank) Underground Storage Tank in.�w/hi hU G / 19gR <br /> storage has ceased but where the owner/operator proposes t-o"RONMENr, <br /> re-use tank within 2 years. PfRAiiT/SfiQi, F�frH <br /> (I Temporary closures x 180) (See above 13 to calculate surcharge) <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 Gank , <br /> (f Permanent Closures x $90) n <br /> S. Plan Check Fee S30. <br /> Total Number of Tanks Qre 'l? Total Fee Due ze.e <br /> r <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br /> with your check, <br /> I <br /> i <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular. 1 unleaded. 1 supreme, 1 waste oil ) <br /> la.. Existing Facility b Ist Tank SI50 <br /> b. 3 Additional Tanks x 150 150 <br /> 2. State Surcharge, 4 Tanks x 156 yid, 224 <br /> Total Number of Tanks 4 Total Fee Duo, $524 <br /> 'Doth closures will he conditioned. Contact.& Health District Representative. <br /> 4 <br /> 2-IlG <br /> y J I <br />