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DBA' -f. r— rtx EAC{ FACT L j10 <br /> 1�Lt,U �cn, F--r,�, csi At� lt <br /> MAILING rrr <br /> ADDRESS RESS <br /> C C f_70 C-4 <br /> O <br /> I• <br /> Operating 9 Permit Application <br /> a• /Annual Inspection Fee <br /> First Tank at <br /> acility b• Additional Tanks @ $250, <br /> • State �_ Additional T <br /> Surcharge {per tank auks x $50) <br /> on renewal ) (Due with Permit A <br /> Or amendment of Application, <br /> ($56 x Total # operation —� <br /> �_ ranks} permit and temporary <br /> �� Tanks) <br /> closure) <br /> Y Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where <br /> the owner/operator —�--� <br /> proposes to <br /> re-use tank within 2 <br /> years. <br /> (0� Temporary closures x $80) (See abov . <br /> *Permanent Closure a #� to calculate surcharge <br /> (Per tank) Underground Storage Tank in which ) <br /> storage has ceased and where ~� <br /> the owner/operator has no intent <br /> of re-using tank . <br /> (� Permanent Closures x $90) <br /> 5. Plan Check Fee $30. j <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 G� 'I <br /> (1 regular, I unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 r <br /> h. 3 Additional Tanks x $50 150 � l <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 /> AI % Is <br />