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ADDRESS �7 � <br /> MAILING � :f�-7o <br /> I. Operating Permit Application/Annual inspection Fee <br /> a. First Tank At Facility P $150. <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 and, temporary closure) <br /> ($56 x Total / Tanks) <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 /> (1_ Temporary closures x $80) (See above 13 to calculate surcharge) <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, ' <br /> (f / Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due G <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br /> with your check, . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (l regular. 1 unleaded, I supreme, I waste oil) <br /> Ia. Existing Facility 6 1st Tank $ISO <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due SS24 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> EH 23 032 2/86 — <br /> AD ART SIGNS, INC. 1082 <br /> SAFETY SUPPLIES <br /> P.0. 90x 9570 <br /> STOCKTON.CA 95206 <br /> <br /> 1".n 11. <br /> Ihi rderul t5AN <br /> N :ti r-z r. � NO'10l <br /> UXION SIOCxip101114 <br /> ewnK =1 WW JIW0 Line <br /> SkK*I..CA Y520) <br /> <br /> <br /> <br />