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rLL WUROHLLI PER EACH FA,:1LI 7-5 <br /> ADDRESS <br /> DBA L FACILITY ` <br /> �2i?/ ADDRESS / rI UUSeVel7z- <br /> MA I L I NG IIDORESS 7 lr'c6P(/c C% <br /> I - Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> . <br /> b. Additional Tanks N �r� 5� <br /> ( �-=Additional Tanks x s50) <br /> 2• State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total +Y___ _ 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 /> (O_Z_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks 0 90 <br /> Make all feest" ���' <br /> payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks p p,�Ma F1e17 <br /> ( I regular, 1 unleaded, I supreme , 1 waste oil ) <br /> la . Existing Facility & 1st Tank5150 fE <br /> ��. 3 Additional Tanks x $50 150yiRON�r,E�1TA1. HEALTH <br /> Z. State Surcharge , 4 Tanks x $56 224 PERMIIZ'cr'yi�-`' <br /> Total Number of Tanks 4 Total Fee Due $524 0'0 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> UC!-T <br />