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_I. .nI_ _ l tAL <br /> � L11T <br /> DBA 0cn1rQ ✓ier tN ADDRESS 35x-'75 <br /> MAILING ADDRESS N <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and teoporary closure) <br /> ($56 x Total N 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 /> (N_ Temporary closures x $80) (See above /3 to calculate surcharge) 5—=') <br /> 4 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 /> 0 Permanent Closures x $90) PAYMENT <br /> RECEIVED <br /> 5. Plan Check Fee $30. <br /> 0 C T b 1988 --(-`� <br /> ENVIRONMENTAL HEALTH <br /> Total Number of Tanks PERMIT/SERVIEOpo a� <br /> � �aI fee Due / <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 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 5524 <br /> "Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />