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E J 531EE1 PER EACH FAC LH <br /> ^"ee , <br /> Catiq <br /> Or '� rat o t r. <br /> k <br /> rar Closure <br /> y (pe F rt ��I+ `' ' rage .Tankto which <br /> 'stgrage has ceased but wh� i r proposes to , <br /> e use.." ank within 2 years. <br /> rary Closures x $80), to uiculate Surcharge) <br /> igsure (per tank) UndE ank in which=,;. <br /> ased 'and where the`,, <br /> + $n <br /> ures x S90) <br /> .. . an Ch ..:,. <br /> Total Number of TanksO T <br /> Total Fee Due <br /> Hake all fees payable to San Joaquin local Health District. Enclose this worksheet <br /> with your check_ <br /> t <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> 0 regular. 1 unleaded, l supreme, l waste oil ) <br /> Ia. Existing Facility 6 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 /> 4.. <br /> •Ooth closures will be conditioned. Contact a Health District Reprtsentattve. <br /> r" - •-- <br />