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DBA t,�;e .c�; 1 , „L,L; <br /> C ADDRESS /S Z AI. U2j'/Lq tjU — Cj 7OG, ,u . <br /> MAILING {1D0RES1A ] xj �7jC) <br /> (`,AG/z QAKfi� C4 to Z <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N Additional Tanks x $50) <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 M 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 /> (k_ Temporary closures x $80) (See above M3 to calculate surcharge) <br /> 1• *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re- <br /> using tank . <br /> (# Perm'anent Closures x $90) <br />;. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due 40. 0 <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, I unleaded, I supreme, I waste oi�1Q. F o <br /> la. Existing Facility A Ist Tank Q p G��` $150 <br /> b. 3 Additional Tanks x $50 f�� 15� <br /> 2. State Surcharge, 4 Tanks x $56 <br /> a��aNF� ,I �l <br /> Total Number of Tanks 4 Total�#' e' 1e6 $524 <br /> 1 <br /> Both closures will be conditioned. Contact a Health District Representative. <br />-B6 <br /> e-7 <br />