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ILL wviuJnit'LH LAO hALIL I <br /> FACILITY <br /> DBA ty�(lrn� �� C>t,� ADDRESS <br /> MAILING ADORFSS _ _33 :j, <br /> 1 . Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (# 2 Additional Tanks x $50) 1 jJ e_- <br /> 2. <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total N3 Tanks) <br /> 3• *Temporary Closure (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 $80) (See above N3 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 /> (K--j Permanent Closures x $90) �C(�Ywui�2¢o 3a ��- <br /> 5. Plan Check Fee $30. <br /> t­%-Total Number of Tanks •Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . <br /> EXAMPLEy� Annual Fee for Facility with 4 Tanks <br /> (1 regular;-+ unleaded, 1 supreme";"-` 1 waste oil ) <br /> Ia. Existing Facility 8 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 /> *Doth closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> 9 1 <br />