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LL. tiuw�hLL i PER EAL11 TALI. <br /> � F1ACILITY <br /> 08A _�� �S P .r/f�.�.Q LS e ADDRESS7 d /1l !�J <br /> - yO e <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P $ISO. <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> 2. State Surcharqe (per tank) (Due with Permit Application® <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 x Total N 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 /> (r Temporary closures x $80) (See above 13 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 /> Permanent Closures x $90) / <br /> 5. Plan Check Fee S30. �— <br /> Total Number of Tanks 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 (� �p <br /> ( 1 regular, I unleaded, I supreme, I waste oil ) l <br /> Ia. Existing Facility b 1st Tank S1SO (�I! <br /> b. 3 Additional Tanks x $50 ISO ' <br /> 2. State Surcharge, 4 Tanks x $56 224 C <br /> Total Number of Tanks 4 Total Fee Due $52.4 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />