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- I- ..vWsj11LLI eLR LALH FALIL! <br /> DBAa�nh .J �I FACILITY <br /> ADDRESS 17fT — s Cameanex 4�'�Q <br /> MAILING ADDRESS / L Mrsmc` <br /> q OO Z <br /> I• Operating Permit Application/Annual Inspection Fee (� 19 g 7 l_._. <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks / (50 —�—�� )SO <br /> ( —�' 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 /> ($56 x Total MI Tanks) <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 /> 4 <br /> (N_ Temporary closures x $80) (See above M3 to calculate surcharge) N <br /> '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 /> (#_ Permanent Closures x $90) <br /> 5. Plan Check Fee S30. <br /> I Total Number of Tanks <br /> Fee Due � ��(p � Is o <br /> T4ai Fee IJ%-)e = 60 G <br /> Make all fees Payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check <br /> 7 ") <br /> EXAMPLE - Annual Fee for Facility with Tan <br /> ( I reqular, 1 unleaded, ] r 1 waste oil ) <br /> la. Existrnq Facilit st ank s1SD <br /> I>. 3 Additional Tanks x $50 S0 <br /> 2. State Surcharge , 4 Tanks x $ /(MNrC 224 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> `Both closures will be conditioned. Contact a Health District Representative. <br /> UC-1 � r <br />