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0.1 , 7�. ,.[1�±� FACILITY � 1 1 ► t ` vy I~lv <br /> .� ADDRESS <br /> AILING ADDRESS �{lnuc kiY*-N{+ S cya AnC� 1SUil <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. PAY <br /> b. Additional Tank n ,RE��IVED <br /> s (M Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, ,JUN 9 <br /> on renewal or amendment of operation permit and temporary {(Cp)MENTAL HEALTH <br /> (b56 x Total N Tanks) PERMIT ISERVICES <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 /> (N Temporary closures x $80) (See above 03 tqqcalculate 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 /> (# Permanent Closures x $90' L9 <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Duel <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . <br /> l <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks p l <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> 1a. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conuitioned. Contact a Health District Representative. <br /> -86 <br />