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•l !'Vk"hLL1 PER EAUI ►ACILIIY (q(j Cc�S a-�L-- <br /> FACILITY <br /> 411A. David iTildenbrand ADDRESS 225 Cherbfee R T�odi Ave. <br /> M1.I0% ADDRESS "h: (20;) 368'7863 ,odi, CA 10524o <br /> I. Operating Permit Application/Annual Inspection Fee �'vG <br /> a. First Tank at Facility P $150. <br /> b. Additional Tanks (I Additional Tanks x $50) <br /> 2. State Surcharqe (per tank) (Due with Permit Application. <br /> on renewal or amendment of operation permit and temporary c1o� A'VM EA/T <br /> (156 x Total /' Tanks) <br /> EIV"1, <br /> 3. 'Temporary Closure (per tank) Underground Storage Tank in whi Ahs G 1 19pp <br /> storage has ceased but where the owner/operator proposes to MV <br /> re-use tank within 2 years. PEkM1T1SERVICES ALTH <br /> (I_ Temporary closures x $80) (See above f3 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 tank . <br /> (f_ Permanent Closures x $90) <br /> on-no <br /> S. Plan Check Fee S30. <br /> Total Number of Tanks One (1') Total Fee Due $ 20.00 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular. I unleaded, l supreme. I waste oil) <br /> Ia. Existing Facility 8 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 y; 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 60oth closures will be conditioned. Contact a Health District Representative_ <br /> 2-1t6 <br />