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f EL NURKSIIi 0 PER EACH FACILi' <br /> FACILIpgA, � • ; TY, <br /> ailld �n.�sQ% Jlo" . ;:tA0DRESDORESS ' �G�1.*.0-j✓ . <br /> MAILING <br /> 04441 <br /> r�f <br /> 1x� 1i <br /> Qperatln `Permit Apppl16 <br /> "T nspectf 1F <br /> '� y, �1 lLi f =� !"�;� {y4 <br /> a .First'Tank at Facility,® 51$9. " <br /> b. Additional Tanks ,(I l ^ gQsditiooaltiTanks 1c. $50) ; <br /> 2. ,State,Surcharge per ,tank MithsPermi't,`gppl1oation. <br /> .14zr <br /> on renewal 'or amendment of operation$ermit4and,temporary' closure) <br /> (S56 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 /> ,closures x f80„7emPorarY )R.(See above , 03- to calculate 5prcharge) <br /> 4• "Permanent Closure (per tank) Underground Storage Tank in'wtiieh! s s <br /> storage, has ceased an here the owner o r for <br /> 4"7 /g Pe !ws no intent <br /> Of re-using tank 1yv'a i" ,vd ,� til it �# �t T <br /> f f V f i f f P I. <br /> ( I_// Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due dP <br /> Make all fees payable to San Joaquin !.oca1 Health District. Enclose this worksheet. <br /> with your check , <br /> PAYIVIEN i <br /> I XAMPIF - Annual Fee for Facility with 4 Tanks RECEIVED <br /> ( 1 regular, I unleaded, 1 supreme, l waste oil ) <br /> f,iAR 1 1988 <br /> Id. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 MVIRONMENTAL HEALTH <br /> 2. State Surcharge, 4 Tanks x S56 224 PERMIT/SERVICES <br /> Total Number of Tanks 4 Total Fee Due S524 <br /> 'Both Closures will be ronditioned Contact a Health District Representative. <br />