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I J'I"m W <br /> E WORy,c%tEET PER EACH FACILITY FACILITY as 1 IN, C� tity��`r <br /> � ADDRESS ^/ <br /> DAA <br /> MAILING ADDRESS c�' J /t <br /> 1. Operating Permit Application/Annual Inspection fee <br /> a. First Tank at Facility @ $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 I 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 /> (#_ 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 , PAYMENT <br /> (1'_—L Permanent Closures x $90) RECEIVED <br /> 5. Plan Check Fee $30. NOV 4 1988 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES c <br /> Total Number of Tanks / Total Fee Due <br /> IyVe ' Si l o cd hackFees on taw 4m <br /> Make all fees payable to San Joaquin ocal Health District. Enclose /t�h`is worksheet.�f9D <br /> with your check. �.il� a3� <br /> S50 ( <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ���-7 <br /> ( 1 regular. 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 l <br /> 2. State Surcharge, 4 Tanks x $56 224 CJ <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> EH 23 032 2/86 <br />