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OQA FACILITY <br /> I �� AUORESS � r <br /> MAILING ADDRESS lu!" <br /> 1 • Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P SIcA. <br /> b• Additional Tanks (/_� Addltional Tanks x $50) <br /> 2. State Surcharqe (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit <br /> ( and temporary closure) <br /> S56 x Total N_L Tanks) � <br /> J• -Temporary Closure <br /> (Per tank) Underground Storage lank in which <br /> storage has ceased but where the Owner/operator proposes to <br /> re-use tank within 2 years. <br /> (I Temporary closures x S80) <br /> 'Pernu,nent Closure (See above 13 to calculate surcharge) <br /> 4 (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 /> ( Y" Permanent Closures x S90) <br /> 5. Plan Check Fee SJO. <br /> RECE 1/ED <br /> Total Numberr JUN 2" 1988 <br /> o Tanks ENVIA®WEF,�,, Due <br /> "+TAL HEALTH <br /> PERAgIT/SERVICES <br /> Make all fees payable to San Joa vin Local health District. ���\� <br /> w' th your check . Enclose(pi sheet <br /> 1 � Q <br /> p <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, I waste oil ) <br /> Ia. Existing Facility d 1st Tank <br /> b. ) Additional Tanks x $50 S15U <br /> 2. State Surcharge, 4 Tanks x $56 ISO <br /> -- 224 <br /> Total Number of Tanks 4 ~ <br /> _ Total Fee Due $52.4 <br /> ,Both closures will be conditioned. <br /> Contacta Nealth Dlstrict Representative, <br />