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rtt WUNKSHCtI PER EACH FACIL� <br /> /� FACILITY <br /> DBA 1p IfiC�lin1� ZOQ14v1 ADDRESS JM(J ( ��4dIL1 S(fe�C II'u°Vltnl n�� <br /> MAILING ADDRES- <br /> ka 11 <br /> CA ( �(n <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. O ' <br /> b. Additional Tanks (# OL,� 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 # 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 /> (d_ Temporary closures x $80) (See above Y3 to calculate surcharge) <br /> *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 /> PAYMENT <br /> (N_ Permanent Closures x $90) RECEIVED —�� <br /> Plan Check Fee $30. OCT 2 194E <br /> .qEW ;✓NSALL�}TIDa) <br /> ENVIRONMENTAL HEALTH <br /> PERI Fee RVI <br /> Total Number of Tanks `� Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District Enclose this work3�lhVPEt <br /> with your check. PAYMENT <br /> RECEIVED <br /> OCT 2 9 1986 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks WRONMENTAL HEALTH <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) RMLT�S1gy10ES <br /> Ia. Existing Facility & 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 /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> 0 <br />