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DBA a, �nuf FACIell" LI TY <br /> 1p <br /> FACILITY • <br /> ilfNG ADDRESS s ADDRESS <br /> , y <br /> u <br /> l Operating Permit Application/Annual ins <br /> a. First Tank at fe Pection fee 7 <br /> Fa' P f150. / <br /> b- Additional Tanks (/ <br /> 2, Additional Tanks x $50) <br /> State Surcharge (per tank <br /> on renewal or amendment of per with Permit Application <br /> ($56 x Total N Tanks) operation permit and temporary closure) <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 /> (/_ Temporary closures x $80) (See above /3 to calculate surcharge) <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-using tank , <br /> (f_ Permanent Closures x $90) � <br /> Plan Check Fee 530. <br /> Total Number of Tanks <br /> Total Fee Due <br />,ke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> ith your check . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks Aq Y <br /> ( 1 regular, 1 unleaded, l supreme, 1 waste oil ) <br /> Ia. Existing Facility b 1st Tank $150 Nov O <br /> b. 3 Additional Tanks x $50 Avk/Rp M <br /> 2 . State Surcharge, 4 Tanks x S56 224 pFRyF�T <br /> Total Number of Tanks 4 Total Fee Due $524 r/SFR���SFq�1NJo / <br /> bk / d J <br /> Doth closures will be conditioned. Contact a Health District Representative. <br />