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FEE woRI(SiiEE T PER EACH FACILITY <br /> FACILITY <br /> Z <br /> Z#f>Itil6`� ADDRESS 7uT�lyy ///ICK( STI TiKh� <br /> DBA <br /> MAILING ADDRESS �? <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a, First Tank at Facility @ $150. t ae) <br /> b. Additional Tanks (M�_ Additional Tanks x 850) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) X �7 <br /> (S56 x Total N d 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 /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 /> Permanent Closures x 890) <br /> S. Plan Check Fee $30. <br /> Total Fee Duej�1 —= <br /> Total Number of Tanks <br /> Make all fees payable to San Joaquin Local Health District. Enclose thfP worksheet <br /> s <br /> RECEIVED <br /> with your check. <br /> NOV Z 1987 <br /> ENVIRONMENTAL HEALTH <br /> EXAMPLE - Annual Fee for facility with 4 Tanks ENVIpERMIT�SERVICES <br /> ( 1 regular, 1 unleaded, l supreme. 1 waste oil ) <br /> 5150 � <br /> Ia. Existing Facility L 1st Tank 150 <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x S56 <br /> 224 i <br /> Total Number of Tanks 4 <br /> Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health Dist Representative. <br /> Z -RG <br />