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"`O" r LIIY <br /> DBA 1/1) . FACILITY `/ <br /> N/7/ V/i'�L- ADDRESS 7�j �f /�7/iL r 72 <br /> MAILING ADDRESS ' <br /> 1. Operating -Permft Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. _ <br /> b. Additional Tanks (M 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 <br /> (per tank) Underground Storage sank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (M_ Temporary closures x $80) (See above /3 to calculate surcharge) <br /> � 4• "Permanent Closure <br /> (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 /> (4--,, Permanent Closures x $g0) <br /> 5. Plan Check Fee $30. CJ <br /> /58 b' Boa„u c lee <br /> Total Number of Tanks <br /> Total Fee Due A( , C <br /> Make all fees payable to S_an Joaquin Local Health District Enclose this worksheet <br /> with your check <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, I waste oil ) <br /> Id- Existing Facility 8 1st Tank <br /> I'• 3 $150 <br /> Additional Tanks x $50 s <br /> 150 - �I <br /> 2. State Surcharge, 4 Tanks x $56 v. <br /> — 224 ;n_ �f <br /> Total Number of Tanks -4- Total Fee Dur S514 n > '' <br /> `Both closures will be conditioned. Contact a Health District Re resentatrve. <br /> 2-86 <br />