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ALL wUHKNNLLIIjPER EACH FACIL� /3 30 -9:S, <br /> /G� �/ L," (`` Y <br /> ADDRESS <br /> MAIAI LING ADDRESS n <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. 1 987 <br /> b. Additional Tanks —'-/ <br /> ( Additional Tanks x $50) 1� C� <br /> 2. State Surcharge (per tank) (Due with Permit Application. <br /> on renewal or amendment of operation permit and temporary closure) <br /> (f56x 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 /> R temporary closures x $80) (See above 13 to calculate surcharge) <br /> 4. `Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where ,th)lowner/opera{torI has no intent <br /> of re-using tank _ U l <br /> (# ; Permanent Closures x f9 _ <br /> 5. Plan Check Fee $30. 11 U/ L� <br /> Y <br /> Total Number of Tanks <br /> Total Fee Due 44 <br /> Make allfees payable to San Joaquin Local Health District Enclose this worksheet <br /> with with your check <br /> EXA.-.PPE - Annual Fee for Facility with 4 Tanks <br /> ( I regular . I unleaded , 1 supreme, 1 waste oil ) <br /> 'a Existing facility & Ist Tank <br /> 5150 <br /> h. 3 Additional Tanks x $50 <br /> 150 <br /> 2. State Surcharge,_ 4 Tanks x $56 <br /> — 224 <br /> Total Number of Tanks 4 <br /> Total Fee Due 5524 <br /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> 2-t;G � <br /> U�-7 , t <br />