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Ye,;, 091Y `,eee <br /> FEE WORKSHEET <br /> DBA �AC���L �AS AniD �1L�2�G �oM�An�y - `a� C�iPS �tOIi��R7i <br /> ADDRESS CD, 45ZoZ <br /> 6 ,av 6�x 980 sToc,�wr7 v ,e4. 9s'aoi <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. _5Q_ <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 /> — .1456 x Total- * L Tank--l_ __.-_._ _. _ -_.. - _---__-_—.—._. 2%91— - <br /> 3. *Temporary Closure (per tank) Underqround Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (#-,L�-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 _�2. <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 1500`�y ��7�(y'��aar1�� <br /> 2. State Surcharge, 4 Tanks x $56 ^__��'_ guy <br /> 111► <br /> Total Number of Tanks 4 Total Fee Due 4 FEB 2 B )98b <br /> ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned. Contact a Health District Representatilv�SERVICES <br /> 12/85 <br />