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tLL WUROHLLI PER EACH FACILV..` <br /> t� /1 fACILITY �,� <br /> DBA r '\_ ' 1 ���YYI f Wn . ADDRESS a L{ a I �—y H1�- • . <br /> MAILING ADDRESS y96 l.0 YIVC-DQ T&CW, & , g5 S76 <br /> 1. Operating Permit Application/Annual Inspection fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (K 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 M 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 /> (N_ Temporary closures x $80) (See above /3 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 /> (# L�— Permanent Closures x $90) to U 1 0 <br /> 5. Plan Check Fee $30. (((('',� l� <br /> MP`s Nis <br /> 1 Total Number of Tanks Ted\G�Ue �D <br /> �N PllM )S <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, I waste oil ) <br /> Ia . Existing Facility & Ist Tank $150 <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 $524 <br /> K `Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />