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n4tv.a11L.L.L rcet,Lcu� rN1.11,y <br /> FACILITY <br /> SCJ ADDRESS <br /> .�� <br /> 4AILIH5 ABORESS <br /> Operaiting Ferri t Apps j+catian/Annul Inspectionlee, <br /> �. first Tarik.At Facility <br /> bd Additional Tanks U Additional; Tanks x $50) <br /> • ` "State Surchar e� <br /> q (Per tahk) (I)ue with Permit:Application. <br /> on renewal or amendment of oeration <br /> P Permit and temporary closure) <br /> ($55 x Total Tanks) <br /> . =' Temporary Closure (per tanks Onderground. Storage Tank in which <br /> storage has ceased but where the owner/operator proposes t4 <br /> re-use',tank within 2 yeairs. <br /> .;Temporary closures x S80) (See above 13 to calculate surcharg <br /> e <br /> *permanent, Closure (Per''tan , underground arage Tank in which <br /> t. <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank. <br /> ( Permanent Closures x $90) ( <br /> 56 plan Check Fee $30. <br /> Total Number of Tanks 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 /> ( l regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x SS6 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> F <br /> .Both closures Will be conditioned, Contact a HeaItb Di strict. Reresentatfve. <br /> 2.-73fi <br />;� T Jf . <br />