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rtes LMAI 9MIL& II <br /> ,._FACILITY b <br /> OBA .. ADDRESS_ 05 � – <br /> MAILING ADDRESS 705 $ . Wq <br /> /9Bb- /f� �y lafo i4af-/SV <br /> 1. Operating Permit Application/Annual Inspection Fee r«y sip 2 007 <br /> a. First Tank at Facility @ $150. 2� /�� <br /> 1L <br /> b. Additional Tanks (/ I.- Additional Tanks x $50) 3 Z <br /> 2. State Surcharge (per tank) (Due with Permit Application. <br /> on renewal or amendment of operation permit andtemporary closure) <br /> (S56 x Total N_�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 /3 to calculate surcharge) <br /> 4. `Permanent Closure (per tank) Underground Storage Tank in which <br /> • -storage has ceased and where the gwner/operator has no intent <br /> of re-using tank, <br /> (I__2=,Permanent Closures x $90) �- <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due (7 — <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check, <br /> i?SC V EV <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks 2,S '096a <br /> (I regular, 1 unleaded, 1 supreme, 1 waste oil ) ASG olk <br /> la. Existing Facility S 1st Tank $1S0 10wtM SVGS <br /> b. 3 Additional Tanks x 150 150 PENS <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 'Both closures will be conditioned. Contact a Health District Representative.. <br /> 2-!"0 <br /> GQT � t <br />