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FEE AORKSHELT PER EACH FACILITY <br /> DBA VIP <br /> FACILITY - _ ` �! ld�e <br /> t�� �l411C � ADDRESS 1fA ( � � <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($.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 /> (#_ Temporary closures x $80) (See above 13 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 , ( g <br /> Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks <br /> Total Fee Due <br /> Make all fees payable to San Joaquin local Health District. Enclose thisA Y M E N T <br /> RECEIVED <br /> with your check. <br /> NOV z 1987 <br /> ENVIRONMENTAL HEALTH <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks PERMIT/SERVICES <br /> ( 1 regular, I unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility S 1st TankE150 , <br /> b. 3 Additional Tanks x $50 150 <br /> ,\ j> <br /> 2. State Surcharge, 4 Tanks x b56 224 �Iv <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a liealth District Representative. <br /> 2 -11,6 <br />