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• M <br /> FEE WORKSHEET <br /> DBA L Rv�&B �' Jyr <br /> //�S <br /> Ste- - cKPA.�t ova S�- Z 'v pis ZED <br /> ADDRESS <br /> lit -- -- . <br /> L Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $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) <br /> (S56 x Total # 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) <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 within next 2 years. . <br /> (# 062 Permanent Closures x $90) <br /> Total Fee Due MO. 00 <br /> Total Number of Tanks 2 <br /> Make all fees payable to San Joaquin Lozal Health Distric''. Enclose tti; worksheet <br /> with your check .,n:,:"� 1 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Du ,A$;5 <br /> i� <br /> PEAR 61086 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> ENVit<Cw�ENTAL HEALTH <br /> F ERMIT/SERVICES; <br /> 12/85 <br />