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rtt WUUKKSHLLI�PER EACH FACILITYFACILIT <br /> p / <br /> DBAC.4 (/p' 07 ��izlvx/�/ ADDRESSY�y/SS � <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $I50. <br /> b. Additional Tanks (/ 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 /> (S56 x Total N 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 /> (/_ Temporary closures x $80) (See above /3 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 /> (I Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks l Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet tt <br /> with your check, <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks 3/ <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) 3(o <br /> Ia. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge. 4 Tanks x $S6 224 Y M E N'I1 <br /> A LECEIVED <br /> Total Number of Tanks 4 Total Fee Due $524, ;.1 <br /> 1 CI 19an <br /> .ENVIRONMENTAL HEALT$ <br /> PE°,'."-i'SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> U6T Q1 <br />