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e rtL wUKK�,HLLI PER EACH FAC11 ''y <br /> ORA FACILIT--� <br /> ADDRESS <br /> Y <br /> MAILING ADDRESS ' >' M W <br /> Operating permit Application/Annual inspection Fee 9 <br /> a, First Tank at Facility to 5150. <br /> b.. Additional Tanks (# Additional Tanks x $50) 0 /Sv <br /> 2, State Surcharge <br /> (Per tank)„(Due with permit Application. <br /> on renewal or amendment of operation'-permit and temporary closure) <br /> ($56 x Total N y 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 /> (d _ -Temporary closures x $80) (See above /3 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 /> (q Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks C_ \VIl a <br /> Total Fee Due <br /> Make all fees <br /> payable to San Joaquin Local Health District Enclose this worksheet <br /> with your check, <br /> Y P .ai <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks T <br /> ( 1 regular, I unleaded, I supreme, I waste oil ) <br /> Ia. Existing Facility b 1st Tank 5150 <br /> b. 3 Additional Tanks x $50 ISO <br /> 2. State Surcharge, 4 Tanks x $56 <br /> -- -- 224 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> 'Both closures will be conditioned. Contact a Health District Reresentative. <br /> 2-80 <br /> UGC a 1 <br />