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. AODRESs I � r-� <br /> MI�,I M:r,NG ADDRESS a , . <br /> 2 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 # 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 /> (r Temporary closures x S$0) (See above 13 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 /> 0 Permanent Closures x S90) PAYMENT ao <br /> 5. Plan Check Fee $30. RECEIVED <br /> 1 <br /> AEJ h !.l, J 19 8�;a <br /> Total Number of Tanks %VIRQ�ENA HEALTH <br /> --- PERMN" � R lts ue <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check <br /> EKAMPLE - Annual fee for Facility with 4 Tank-, <br /> ( 1 regular. i unlr.,I(lctl , 1 "upromo , I Wa%Le oil ) <br /> la. Existino Facility S i;t Tank 5150 <br /> 1). 3 Additional Tanks x $5(] 150 <br /> 2. State. Surcharge, 4-Tanks. x S56 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 /> 9a-r --� I <br />