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ftE, k'si �;;Ef�l" PER EACH fAC1L1lY• • <br /> �wtr <br /> FACILITY A $S 5D inO Sr u <br /> ILINf, ADDRESS IOSV Q. UU,QJ S <br /> perating Permit Application/Annual Inspection;Fee <br /> 15a,C3t7 <br /> b opera nanporary closure) <br /> STan a;. <br /> per Underground Storage Tank in which <br /> eased but; th ,ow►►er/operator proposes to <br /> inn ye <br /> nsure s x $80) (See above 13 to calculate surcharge) <br /> Undergr�)und Storage Tank in which <br /> ere the `owner/operator has.. no intent;. <br /> 6 r-3 <br /> 9a.azo <br /> Assoc n�5s <br /> GC�ou <br /> � <br /> Tanks <br /> Total Humber of 4 , - <br /> Total Fee Due '2,4b <br /> Make.all-;fees payable to San Joaquin Local Health District. Enclose this worksheet)q s <br /> with your check. <br /> EXAMPLE Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility 6 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. Slate Surcharge, 4 Tanks x SS6 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> - <br /> — *Both closures will be conditioned. Contact a Health District Representative <br /> o <br /> 2-8V, <br />