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n FACI L I TY <br /> 0$A . 6�� '►y ADDRESS <br /> ILING ADDRESS -� ' N /� <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. /J`Q <br /> b. Additional Tanks (t Additional Tanks x $50) <br /> -State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit an . temporary closure) <br /> (556 x Total N .S 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 13 to, calculate surcharge) <br /> i• "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 /> Plan Check Fee $30. copy <br /> �0 1 <br /> Total Number of Tanks ..3 Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />