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FEE WORKSHEET PER EACH FACILITY <br /> DBA �ir Lew AODRESSY Til(o "f <br /> 4 MAILING ADDRESS SJRy <br /> db 8� 8�1 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. /fib lSb <br /> b. Additional Tanks (I_ f 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) �(o <br /> ($56 x Total I_I Tanks) <br /> 3. *Temporary Closure (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 I3 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 /> (I_L Permanent Closures x $90) �C <br /> 5. Plan Check Fee $30. <br /> I / UU( ao <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> P <br /> (6000-0�011111' EMIL A. LEER1894 <br /> _ MARY H. LEER���++� STO KION,CHERRYLAND9 AVE. 931X956"--�""- STOCKTON, CA 95205 <br /> � <br /> <br /> 4-46 f150 <br /> ISO <br /> 50 <br /> 224 <br /> SIO((RION S1VIW <br /> 5524 <br /> 1]I M. ET• �� � f..'�I <br /> i; � <br /> - _.... <br /> T�?"•8oth closures will be conditioned: ContacC a Heartn urs[ricc Kt Ave. <br /> 2-!SG <br />