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L^%,11 rALIL <br /> DBA <br /> '-AFAC <br /> ��> ADDRESS L(,) <br /> MAILING <br /> MAILING ADDRESS C�OSE�t/C /7� �SOi44j/(l <br /> 7 <br /> I • Operating permit <br /> Application/Annual Inspection Fee <br /> a. First Tank at Facilitv P $15A. <br /> b. Additional Tanks (N -t5l--Additional Tanks x $50) <br /> 2• State Surchar e <br /> 9 (per tank) (Due with Permit Application, ---- <br /> on renewal or amendment of operation <br /> (S56 x Total N_� Tanks) Peet and temporary closure) <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) <br /> 4• ~Permanent Closure (See above 13 to calculate surcharge) <br /> (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tanks <br /> (#—Z_ Permanent Closures x $90) <br /> 5• plan Check Fee $30. <br /> Total Number of Tanks <br /> Make all fees payable to San Joaquin local Health District. Encloste th <br /> with your check --—--- �s worksheet <br /> FXAMPLF A„r1 Fee for Fac i 1 i ty with 4 Tanks <br /> PAYMENT <br /> ( 1 r�'qular, 1 unleaded , 1 Su �remC, REGEtVED <br /> ( 1 waste oil ) <br /> 1 � . Fxrsttnrl Facility R lst Tank ' �'� <br /> � t: <br /> ( . i Additional Tanks x S50 S150 <br /> 150 urAl7H <br /> 1. Stat(' Suerchar 4 ►yV_IRON <br /> 9 ---Tanks x S56 224 PERN\,ri- <br /> Total Number of Tanks 4 <br /> Total Fee Due 5524 <br /> Both closures will be conditioned. <br /> Contact a Health D9strict R��resentative. <br /> 86i <br /> f <br />