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FEE WQ9.W. ET PER EACH FACILIT� M <br /> ' FACILITY <br /> DOA I'n H(Uuu(, L.ITY ADDRESS 134 S � - <br /> MA I L I NG ADDRESS GYF <br /> 1. Operating Permit Application/Annual Inspection Fee _ <br /> a. First Tank at Facility @ $150. 15 O I �O <br /> b. Additional Tanks (/� Additional Tanks x $50) SC <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) I ` Z <br /> (S56 x Total N 2 Tanks) <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 /3 to calculate surcharge) <br /> 4. "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the gwner/operator has no intent <br /> of re-using tank, <br /> (o 2— Permanent Closures x S90) ' a� <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due Z <br /> Make all fees payable to San Joaquin Local Health District, c ose this worksheet <br /> pAYM IF <br /> with your check. Vtr <br /> OCT h 1988 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ENVIRONMEPERM I STRVI4ES LTH <br /> 2 � <br /> ( 1 regular, 1 unleaded, l supreme, 1 waste oil) <br /> Ia. Existing Facility E 1st Tank 5150 <br /> b. 3 Additional Tanks x $50 150 A <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-26 • • <br /> UG7 � I <br />