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DBA i� C� FACT L I TY <br /> ADDRESS fC'iC'� f <br /> MAILING ADDRESS <br /> 1 Operating Permit APPlicatiuli/Annual Inspection Fee <br /> a, First Tank at Facility to $150. <br /> b. Additional Tanks # <br /> Additional Tanks x $50) --- <br /> 2• State Surchar a tom. <br /> 9 (per tank) (Due with Permit Application, `s on renewal or amendment of operation permit and temporary closure <br /> ($56 x Total Tanks) ) <br /> 3• 'Temporary Closure ( <br /> 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) <br /> 4• (See above #3 to calcula <br /> "Permanent Closure <br /> (per tank) Underground Storage Tank in which rcharge) <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank . <br /> (#--L Permanent Closures x $90) <br /> 5- Plan Check Fee $30, <br /> � Total Number of Tanks 1 <br /> I Total Fee Due r � <br /> Make all fees payable to San Joaquin Local Health District. <br /> with your hart- Enclose this worksheet <br /> SAN JOAQUIN VALLEY REGION <br /> F.G. $ E. Co. 7 9 4 L. <br /> EXAI ,„ REGIONAL PETTY CASH FUND 1 <br /> + 1401 FULTON <br /> FRESNO, CA 93760 -4~ � 17-35/1210 <br /> e u de of l.lr of <br /> 1W <br /> Bank of America <br /> Fresno Mainoitico oolo <br /> P.O.Box 1672 <br /> Fresno,CA 93717 <br /> oth closures will be conditioned. Contact a Health District Re resentative, <br /> 2-t36 <br /> r <br />