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" "n""LLL rt.N tAL11 $-ALI LI I <br /> FACILITY <br /> OBA rj )'Cf Irl - �T�n>/� ADDRESS /C'S60 -S. <br /> ` i7nCit�l/ �G FE�k iyP <br /> MAILING A,00RESS 0f—d�6M P9 952oI <br /> 1. Operating Permit Application/Annual Inspection Fee _ _^! iV 19 E7 <br /> L L, <br /> a. First Tank at Facility @ $150. � LEy <br /> b. Additional Tanks (N_ g Additional Tanks x $50) FED 18 1988 yon <br /> 2. State Surcharge (per tank) (Due with Permit Application. GP%Uji[ECONSIfiUCTIDNCO <br /> STOCKTON <br /> on renewal or amendment of operation permit and temporary closure) <br /> 456 x Total M_-,L�—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 /> (Y_ Temporary closures x $80) (See above l3 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 /> (N Permanent Closures x $90) �- <br /> 5. Plan Check Fee $30. <br /> O <br /> Total Number of Tanks Total Fee DueQ <br /> YIELD C.1wbit = L 31 g <br /> b7.. TotRL Fee Dvc <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet r----- <br /> With your check , :.ail JUA(�tfi LJ P.L }IED.LiII U�STi;ii l <br /> POS'. OFFICE E70:: 2009 <br /> STOCKTON. CALIF. 9-L201 <br /> ATTN: EfJVIRONI. I!EALl l <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular, I unleaded , 1 supreme, 1 waste oil ) <br /> la. Existing Facility & lst Tank $ISO RECEIVED <br /> ECEIVED <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge,_4 Tanks x $56 224 Ftl) 1 <br /> ENVIRONMENTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $524 PERMITISERVICES <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-116 <br />