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Wuw��►iLt a PLN LAW fACILI IY <br />FACILITY <br />JBA �Jl. ADDRESS 16 _.act EaO 'a; O <br />=--- <br />MAILING ADDRESS ^tocl-tcr_, CA 05205 <br />—cam 4-- <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank At Facilitv P 115. <br />b. Additional Tanks (I Additional Tanks x $50) <br />2• State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary closure) <br />M6 x Total M Tanks) <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 />(M Temporary closures x $80) (See above r3 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. PAYMENT <br />(I = Permanent Closures x $90) RECEIVED <br />S. Plan Check Fee S30. AUG 11988 <br />.ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />Total Number of Tanks one (1) 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. <br />Ia. Existing Facility b 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge. 4 Tanks x $56 <br />Total Number -of Tanks 4 <br />1 waste oil) <br />S1SO <br />150 <br />224 <br />Total Fee Due, $524 <br />'Both closures will be conditioned. Contact a Health District Representative. <br />2-110 <br />