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DBA / a6iN5 FACILITY <br /> MAILING ~!ADDRESS <br /> r <br /> I. Operating Permit Applicatiuii/Annual Inspection Fee <br /> a. First Tank at Facility @ S15Q. , <br /> b. Additional Tanksy - <br /> ( �^-�? Addi tianal Tanks x $50) � <br /> 2, State Surcharge (per tank ---�- <br /> � (Due with Permit Application. <br /> on renewal or amendment of operation permit and temporary closure) <br /> (SSG x Total N r 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 /> (K Temporary closures x $$0) (See above N3 to calculate surcharge) <br /> Permanent Closure ---- <br /> (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of 're-using tank . PAYMENT <br /> (# Permanent Closures x $90) RECEIVED — <br /> 5_ Plan Check Fee $30. OCT 27 <br /> 1988 <br /> jtjW0t4MENfAC HEACT <br /> PERMIT(SEPWICES <br /> Total Number of Tanks <br /> Total Fee Due <br /> Make all fees payable to San Jo a uin Local Health District. Enclose this worksheet <br /> with your check <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, I unleaded , l supreme, 1 waste oil ) <br /> la. Existing Facility & lst Tank $150 <br /> 1). 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $57.4 <br /> `Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />