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tcc wuwcNHitl PER EACH FACIL% <br /> 08A Z260 0 0, FACILITY <br /> ? ie / " DRESS 17-./1 �} E u rs/ 1W <br /> MAILING ADDRESS�� s' w 11D <br /> ��� �� sty - <br /> I• Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilit.v @ $150. <br /> b. Additional Tanks (N 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 N Tanks) <br /> 3- `Temporary Closure <br /> (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 N3 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 /> (N Permanent Closures x Ego) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks <br /> Total Fee Due Jl` 00 <br /> Make all fees payable to S_an Joaquin Local Health District Enclose this worksheet <br /> with your check <br /> A <br /> EXAMPLE - Annual Fee for FaCiIIty with 4 Tanks RFCF EN <br /> AVeQ( 1 regular, 1 unleaded, 1 supreme, l waste oil ) <br /> la• Existing Facility 8 Ist Tank S150�IVVIRO � (, i <br /> h. 3 Additional Tanks x S50 N <br /> 150 PERM'%SFI)�' � Nfq(T <br /> 2. State Surcharge , 4 Tanks x 556 <br /> --- 224 ifs h <br /> Total Number of Tanks 4 <br /> — Total Fee Due $524 <br />'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-116 <br />' C,-7 l • <br />