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.�, <br /> "N <br /> T`hT�Hf TSL" <br /> `b.'� Addii; onal a r. r i; a w �s <br /> y ✓ y( <br /> . R ft __ q I' '� f� Y 1�, �R�'I hY� ��t �-'• '1 �` A y'G <br /> Mate Surchargepe nk) (Due ifh arm <br /> 4 r, <br /> 3ef .h`R. 1S $Tiayv <br /> 1• 'Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceasedbut where the owner/operator proposes to PAYMENT <br /> REGEWED <br /> ,"re-use'tank within 2 years. <br /> �., <br /> Temporary closures x $80j °(See above 43 to calculate surcharge) irA( <br /> ZLl _ - <br /> i. �Permanentosure (per tank),Underground Storage Tank in which ]ENVIRONMENTAL HEALTH <br /> orage-has`ceased_ and where the owner/operator has no intent PERMITISERVICES _ <br /> =of :re-using,tank <br /> ;', <br /> (l-Permanent Closures x $90) IV <br /> i. Plan Check Fee $30. cxel� <br /> 017 <br /> Total Number f Tanks Total Fee Due <br /> o a ks �� 3cj�IY <br /> Make all fees payable to San Joaquin Local Health District. Enclossethis worksheet <br /> lv7A� /nuc <br /> with your check, Vie . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, I supreme, 1 waste oil ) <br /> la. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <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 /> Z-;4G <br /> T <br />