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J t#. WORK ILL i, R <br /> �: <br /> Pr n <br /> � . <br /> 'OBA .,. .10 <br /> 1. Operating N ': <br /> • <br /> b. Additioi > �,= rid, r y g y <br /> F <br /> �. :, State Surrb a� <br /> on_renewal aramet oprafii+�n pet ovary 'i=osure} <br /> ($56 x total ' Tanks) <br /> 3. *Temporary Closure-' tank) Underground Storage Tank in.which <br /> storage has ceased abut where _the`;+ mer/operator" proposes to <br /> re use tank',w, 04 ears. <br /> t "'.�rraerz A .#� a �ate5 viY� W6 � <br /> 4• '*Permanent Flo: en 1unc mound a tangy ih which <br /> tore�hao ,�ten�t A; � x <br /> a <br /> of areusing� <br /> (N` Pw r $' <br /> e <br /> a pr <br /> �5,. Plan Ch ecl Fee' <br /> n <br /> s. <br /> x <br /> d'W <br /> Total Near t!f <nE a arL Totat;`rFee 1)ue <br /> y <br /> A <br /> Make all fees payable to San Joaquin local Nealth District. Encio* heet <br /> with your check. <br /> _ �� <br /> EXAMPLE Annual Fee for Facility with -0 Tanks RV/CESLrN <br /> (1 regula"r, l unleaded, 1 supreme. 1 waste oil ) <br /> Ia. Existing Facility & lst Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2< State Surcharge. 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will t conditioned. Contact a Health District Representative. <br /> 2-116 <br /> Poo of d r <br />