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F I ( WORL:,Hi l 1 Pi 1Z I A(ll I A( 11 11 Y C(iLLFGE\7L1.E SCHOOL <br /> IACII11Y 6901 S. Jack Tone Road <br /> DBA ADDRISS <br /> Stockton, Ca. 95205 <br /> MAI I ] NG ADDR[SSESCA U)1.' CR:IFIEn SCHIXOL nISTRICT, 1520 yosenite Ave., Escalon, Ca. 95320 <br /> 1 . New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (k Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total p 1 Tanks) 56.00 <br /> 4. *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 /> (# 3. Temporary closures x $80) (See above k3 to calculate surcharge) 80.00 <br /> 5. *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 within next 2 years. <br /> (#_ Permanent Closures x $90) <br /> Total Number of Tanks 1 Total Fee Due 136.00 <br /> B� <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 & 1st Tank �IV (ryl <br /> b. 3 Additional Tanks x $50 D u (y+ U <br /> 2. State Surcharge, 4 Tanks x $56 24IAAR 2 5 19bb <br /> Total Number of Tanks 4 Total Fee Due M` fROMENTAL HEALTH <br /> F ERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative <br /> 2-86 <br />