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1#y EE WORK5l�CE� PFR EAGC FACIi.Iley <br /> x <br /> x{ FRCIt. <br /> J- DRES <br /> tw,'}.'�a <br /> w i9x ,s a i. .'S•..yy <br /> R4 <br /> i <br /> S r .�f <br /> 4 - <br /> A r <br /> } �ry Pe1 ng?Pent1 ` PpIi6at �6hjm, t�a�s aPet lion fee " <br /> i � •r` - t _ tri <br /> i a g F rst rank +L .18 �$3tr 31 <br /> yj. b-0 Add tional `.Tanks. I Additio al Tarjks x $50) <br /> 2 i State Surcharge 4°per <br /> tank} Due W trh Per mi t Application.,. <br /> on renewal or arwndment of operation permit and temporary closure) <br /> (556 x Total <br /> 3• .�Tempora.ry` Closure (per tank) Underground Storage Tank in which <br /> storage has' ceased but where the ownerloper°ator proposes to <br /> re-use tank within 2 ,years. <br /> ��' Temporary closures x $84} (See ILX)Ve 93 to calculate surcharge) <br /> �. "Permanent. Closure (per tank) Underground Steerage Tani- in which <br /> storage has ceased and where the ownerioperator- has no intent <br /> of re-using tank. <br /> (� Permanent Closures x $9Q) PAYMENT <br /> 5. <br /> AYMEIV1°5. Plan Check Fee S30. �ECEI V E0 0 <br /> MAY 3 <br /> Total Number of Tanks HWTj4 Total Fee Due <br /> - _. RMiTjSI_R VICES <br /> Make all fees payable to San Joaquin Local Health District. Enclose this woik.shcet. <br /> with your check,. <br /> EXAMPLE Annual Fee for Facility with 4 Tanks <br /> ( l regular, 1 unleaded, l suprcmcs>, l was,te'k11 <br /> Ia. Existing Facility & lst Tank $150 <br /> b. 3 Additional Tanks x $50 x,50 <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 i, Health 'District Re resentative. <br /> 2-; 0 <br />