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J <br /> 1 (�I. L11 \ <br /> Oak anc�r< �� ADDRESS /a v 'S- <br /> MAILING ADDRESS Cr �o� cStoGk�arl ` /� <br /> 1�8� t�$7 r9a 8 <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> ISO 1540 5 a <br /> b. Additional Tanks (/ 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 0 / Tanks) S� <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 owner/operator has no intent <br /> I <br /> f re-using tank <br /> (lf Permanent Closures x $90) 9� <br /> 5. Plan Check Fee $30. <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. 5�6 co <br /> PAYMENT <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks RECEIVED <br /> ( 1 regular. I unleaded, I supreme. 1 waste oil ) OCT 2 II 1988 <br /> Ia. Existing Facility E 1st Tank $150 ENVIRONMENTAL HEALTH <br /> b. 3 Additional Tanks x $50 150 pEgMITISERVICES <br /> 2. State Surcharge. 4 Tanks x $56 224 Q �(, n :5ti4( � <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> `Both closures will be conditioned. Contact a Health District Representative. <br /> EH 23 032 2/86 <br />