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II- �/ I f\y l�.e r r <br /> `"U^ S- YOG�14/Gt yT tT ADDRESS 4-7U0 S r <br /> t ►,AiL1Nc nooREss ,viron <br /> 1. Operating Permit Application/Annual I,peetlon <br /> Fee <br /> a. First Tank at Facility @ $15o. <br /> b. Additional Tanks (I Additional Tanks x 450) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> 456 x Total M � Tanks) 57Uo <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 /> Temporary closures x $80) (See above 13 to calculate surcharge) <br /> `!0 4- <br /> `Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-Osing tank _ <br /> ( M_ Permanent Closures x $90) AR <br /> S. Plan Check Fee $30. R�C4-itA ► 38,00 <br /> 190t 9 I'd <br /> I �,yl,�R� /9490 <br /> Total Number of Tanks l � /y Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check _ <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, I supreme, 1 waste oil ) <br /> la . Existing Facility R lst Tank SI50 <br /> b. 3 Additional Tanks x $50 ISO <br /> 2. State Surcharge, 4 Tanks x SS6 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 'Both closures will be conditioned Contact a Health District Representative. <br /> 2 -66 <br />