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I <br />(LING ADDRESS <br />-. . 1,.,1111 J <br />Et GON <br />. , rAla, 040e,4, L.4 <br />Operating Permit Application/Annual Inspection Fee <br />K W&! <br />g5-&zv <br />a. First Tank at Facility @ $150. Z <br />b. Additional Tanks (N Additional Tanks x $50) <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary closure) <br />456 x Total M Tanks) <br />*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 />0 Temporary closures x $80) (See above N3 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 />(N Permanent Closures x $90) <br />Plan Check Fee $30. <br />Total Number of lanks <br />e all fees payable to San Joaquin Local Health District <br />h your check. <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, <br />la. Existing Facility & 1st Tank <br />I>. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />Total i cc uuc to •,J <br />1 <br />Enclose this worksheet <br />1 waste (BYMENT <br />1�PCEIVED <br />$150 <br />E�!`'IkON,ti1=tJTPY�4cAL7H" <br />Total Fee Due $524 <br />h closures will be conditioned. Contact a Health District Representative. <br />a r!.lit <br />MS.ASIPJC <br />