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nunn�i��Ll VLK LAW hACILITY <br /> FACILITY _ <br /> DBA � /C �P67/♦ ro `�y/C/� ADDRESS z//`;- <br /> MAILING ADDRESS <br /> 1 98c, 198 I m <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P 1150. <br /> b. Additional Tanks (N r Additional Tanks x $50) O <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 I 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 /> (b_ Temporary closures x $80) (See above N3 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 /> (M I Permanent Closures x $90) CSC. <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks I Total Fee Due 10(�' 56 (.4C <br /> Make all fees <br /> payable to San Joaquin Local Health District. Enclose this worksheer '-- <br /> with your check . <br /> r., <br /> EXAMPLE - Annual Fee for Facility with 4- Tanks p Fz: ;u V <br /> n <br /> rrID <br /> ( 1 regular, 1 unleaded , 1 supreme , 1 waste oil ) < n <br /> Ia. Existing Facility & 1st Tank $150 Z Th <br /> b. 3 Additional Tanks x $50 ISO rr--, <M <br /> 2' cc � � <br /> 2. State Surcharge, 4 Tanks x $56 224 rn d <br /> x, <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 /> UST ar <br />