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FEE WORKSHEETdl��6 e <br /> DBA n�iia 2 u S Q POPPcie= owrve�2 � .1 J Co.. /PC ZAA,+K 04%vC2 <br /> ADDRESS RSOo S CAGCFO.Qd//A Sr Srpgxr&kv 04 9-V206- <br /> 1. <br /> 52061. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. �Sy <br /> b. Additional Tanks (# Additional Tanks x $50) �►- <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($, x .Total Tants) <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) <br /> 4. *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 within next 2 years. <br /> (# Permanent Closures x $90) <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 and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 SOSIO <br /> 2. State Surcharge, 4 Tanks x D56 ' <br /> ��M� 2244 Z�N <br /> Total Number of Tanks 4 Total Fugeeue $52 iN Q 1� \�aF` <br /> 111���111"' FEB 5 1� �ox59520� <br /> pN ►ROMENTAL HEALTM P n GP <br /> *Both closures will be conditioned. Contact a "a p1QT$5r4kWP%presentative. =�Qr <br /> 12/85 <br />