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.... m......w.. .ro•'e�rae�axZ'eRwtlW.�_+:kXw4vi.,�:n�. y 'cT3 vt•�.�1`�"tlL <br /> DBA )~r�;., Sard�„ <br /> FACILITY <br /> ADDRESS <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee g b rl ^ <br /> a. First Tank at Facilit,v @ $150. r(3) S <br /> � oo.00 <br /> b. Additional Tanks (N I Additional Tanks x $50) <br /> 2. State Surcharge (per tank <br /> (Due with Perini[ Applicailon, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 x Total N - 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 /> (N_ 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 /> (N z Permanent Closures x $90) Iko. o <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Z <br /> Total Fee Due X92. <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 Tank,, <br /> ( 1 reqular, I unleaded , 1 Supreme, I waste oil ) <br /> Ia. Existing Facility ,S Ist Tank S150 <br /> b. 3 Additional Tanks x S50 ISO <br /> 2. State Surcharge.-4 Tanks x S56 P24 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-8G <br /> 1-r -71 <br />