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ttt WUKKSHLLI PER EACH FAC'''T <br />DBA 57/c�V 00 06 FACILITY <br />ADDRESS <br />, .S f� , , Q 9szi z <br />MAILING ADDRESS 1�6'r/ � <br />�r 0, 3� � 7 --' /��(% <br />7- <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (N Additional Tanks x $50) OCT 27 Wb <br />2. State Surcharge (per tank) (Due with Permit Application <br />thVIROMENTAL HEALTH <br />on renewal or amendment of operation permit and temp4*?Eil VWgtVICE$ <br />($56 x Total N/ Tanks) S� <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 N3 to calculate 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 />(8_ Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Sa° to -71 <br />1 24-0 <br />Total Number of Tanks <br />% Total Fee Due <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with your check. <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, 1 waste oil) <br />la. Existing Facility & 1st Tank $150 <br />b. 3 Additional Tanks x $50 I50 <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 />2-86 <br />