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} <br /> r L'L%WURK•JHLL 1 PER EACH FACT LO <br /> (} FACILITY <br /> 408A �r, rx I i n_� }'rl/ 0 ADDRESS F ' I .,,, <br /> MAILING ADDRESS p o v CA S <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (q a Additional TankspP $50) M�NoP�\GF5 ) O(� _ <br /> 2• State Surcharge (per tank) (Due with Permit A lication �N Q M�'Ig6 <br /> on renewal or amendment of operation permit and temporary closure) <br /> 456 x Total # 3 Tanks) <br /> � SS - <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 /> t (q_ Temporary closures x $80) (See above q3 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 /> (q_�3 Permanent Closures x $90) <br /> 5. Plan Check Fee $30. �_ <br /> g Total Number of Tanks j Total Fee Due /Z- 7 / $ <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksh tS j" <br /> with your check , <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 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 $56 P24 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> L *both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> U 6T a t <br />