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' LL "UnJIILti VLH LALH FALILI <br /> pcDOc to Rr . <br /> 1%" FAC I L I TY logo C, \ <br /> DBA c `GL'6e , UooA C� ADDRESS �L T.oc`Cc os-aJ S4 l �A .�. <br /> ,MAILING AODRESS- •L7 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (tl 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 /> (856 x Total tl 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 /> (tl_ Temporary closures x $80) (See above M3 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 /> (#_-L_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> s <br /> 6 �— <br /> Total Number of Tanks Total Fee Due t] <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 /> Ia. Existing Facility 8 1st Tank 5150 <br /> 6. 3 Additional Tanks x 850 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Duey 5524 <br /> `Both closures will be conditioned- Contact a Health District Representative. <br /> 2-Y,6 <br />