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rtL NUH01iLLI PER EACH FACILIT <br /> � `/ FACILITY <br /> DBA f3iU /P�2Cf �l - aiyy('�rrilf ADDRESS 106-00 <br /> MAILING ADDRESS /:�10 0� M riq 90-?o / <br /> 1. Operating Permit Application/Annual Inspection Fee r987 <br /> a. First Tank at Facility @ $150. )y <br /> b. Additional Tanks (# Additional Tanks x $50) Z46 n <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 N�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 N3 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 /> (q_ Permanent Closures x $90) $ <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due '550 <br /> M6 CR6o <br /> 14 8-7 To+A-L Fee Due =al a 3� <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 /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility 8 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge , 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> `Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />