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08A P. (P4 - FACILITY <br />t MAILING <br />ADDRESS I4S-o — w K (Z <br />I. Operating Permit <br />a. First Tank at FacilitApplication/Annual inspection Feet. <br />�x <br />v P $IS(). <br />b. Additional Tanks (1 Additional Tanks x $50) <br />7• State Surcharge (per tank) (Due with permit <br />on renewal or amendment of o Application. <br />Aeration permit and temporary closure) <br />($56 x Total I 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 />0_ Temporary closures x S80) (See above 13 to calcul ae _i,t <br />4• `Permanent Closure (per tank) Underground St rge) <br />fink=°ilk <br />storage has ceased and where the owner{opera as no intent <br />of re -using tank, <br />., rJ <br />(N_ Permanent Closures x Sgo) <br />S. Plan Check Fee S30. ENVIRUMtE" `ARMC HEALTH <br />E ERW/cx <br />Total Number of Tanks <br />Total Fee Due"— <br />Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br />with your Check <br />CJ-�Lxl s3f5 <br />E AAMC r -(. A9 O•w <br />_ L• - Annual free for Far illiv wlih 4 Tank•: <br />(I r'rCu l.tr. 1 ur11,'30''j. 1 Suprrr"'• I uaS C,' all) E (F <br />la. ExtS(Ing farilttr .S Ist Tan; <br />S I S(1 ,re.tnnov�•Q <br />h. 3 t•rldt t lona 1 T.tnk% x SS(1 <br />Stl <br />Statr Surcharge• 4 tanks x S56 <br />224 <br />Total Number Of Tanks 4 <br />Total Fee Due 5574 <br />'Both closures will be conditioned. <br />Contact a Health District Representative, <br />2-86 <br />%C-- 21 <br />