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WORKSHEET PER EACH 'FACI,Lr`'' ' I I Alpine Sc` of <br /> FACILITY 15777' No ..1pine, Road, <br /> DBA lodi Unified School ,Disttict AODRES5 1bdi "'a� 95240, <br /> MA! LING ADDRESS 815 West Lockek.ord Street, j�j eA 954ap ' <br /> I New Facility or Addition ' <br /> a. First Tank $180. <br /> b. Additional Tanks (# i Ad8iti,ohal ,T'anIk5 .x $5011 <br /> 2 Operating Permit Application/AnnuaT Inspection Fee <br /> a. Existing Facility and, lst, Tank,,@ $150. <br /> b. Additional Tanks (p Additional Tanks x $,5,0) ' . <br /> Statre Surcharge (per tank) (Cue with Permit Appliretion, <br /> on renewal or amendment of .o p'eration', permit and temporary closure) <br /> ($56 x Total li Tanks)' <br /> "Temporary Closura (per tank) UnderI ground StoranP T'�i in which <br /> storage has ceased but whe,r.e, the owiner/operator propos" to <br /> re-use tank within 2 yearsr, , <br /> Temporary closures z '$80) ($ee above3 to ;ca'1<u'late surcharge) <br /> "Permanent Closure (per tank,) iUndergrpund .storage, an <br /> lTk,�in—whicF <br /> storage has ceased and where the, owner/operiltor has pp intent <br /> of re-using tank within next 2 years. <br /> ( #_1 Permanent Closures , $90) 90. <br /> Total Number of Tanks L Total Fee Due 90• <br /> M,jke all fees payable to ' Sanldi Local kedlth DiSt'r,i't4 Enclose this worksheet <br /> u . th vour check . <br /> EXAMPLE - Annual Fee for' Facitity with 4 Tanks , <br /> -- - (1 regular, 1' unleaded, t.supreme, S Wa,stel oiI <br /> Ia. Existing Facility & Ast Tank x,$1,50 <br /> b. 3 Additional Tanks X $50; ",' 150 <br /> 2. State Surcharge, 4 '7ahks x $56 224 <br /> Total Number of itanks 4 Total Fee Due 0524 <br /> 'I;oth closures will be conditioned Contact a Health Dis>;rict Repnesehtati',v,e: <br /> r. <br /> -86 �' <br />