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M LALJJ VA <br /> 4A4 <br /> OBA eA L 2FACILITY <br /> MAILING ADDRESS ADDRESS <br /> 1 Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $_15.0. <br /> b- Additional Tanks (q <br /> 2. Additional Tanks x $50) <br /> State Surcharge (per tank <br /> on renewal or amendment of operation Permit Application, <br /> permit and t <br /> ($56 x Total y temporary closure) <br /> 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 /> (N_ Temporary closures x $gO <br /> 4. *Permanent Closure ) (See above #3 to calculate surcharge) <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 <br /> (1-4'Permanent Closures x $90) <br /> 5. Plan Check Fee $30. �— <br /> Total Number of Tanks <br /> Total Fee Due b� <br /> Make all fees payable to San Joa2uin Local Health District <br /> with your check. Enclose this worksheet <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, I waste oil ) <br /> la. Existing Facility & 1st Tank <br /> b. 3 Additional Tanks x $50 $150 <br /> 2• State Surcharge, 4 Tanks x $56 150 <br /> 224 <br /> Total Number of Tanks 4 <br /> -- Total Fee Due $524 <br />*Both closures will be conditioned. <br /> Contact a Health District Representative. <br />'-86 -- <br />