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rtt WUROHLU PER EACH FACILII6 <br /> DBA C-� FACILITY <br /> k-t--(f r061 <34-u ADDRESS ', % `�+��� - r S-4/t- <br /> MAILING—A©DRESS <br /> I. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (# 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 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 $$0) (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 /> (# q Permanent Closures x $90) 73U0- <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due ' s <br /> Make all feesa able to San Joaquin Local Health District. Enclose this worksheet�41 �� <br /> P Y 9 <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 $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 />