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}� ,f EE NORKSHLE1.IPER, EACH, FACYL:TY . . <br /> DBA �/�il'R1_ �"d�� �1ZZ9e CO ADDRESSFACILITY <br /> MAILING ADDRESS <br /> t. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ $150, <br /> b. Additional Tanks (/ 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 /> 056 x Total 0 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 f3 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 $90) <br /> S. Plan Check Fee $30. + <br /> Y <br /> 5 <br /> F <br /> Y <br /> F //11 � <br /> Total Number of Tanks -2 Total fee Due 7j <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> Lp <br /> on.:;•�5 ei�"^;r7c4. �`°�� '�.L k'. _. .:.� A �.i i yrs.�. a '.:3' � � i 7;:s4?i v . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, i unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility b 1st Tank 5150 <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 5524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> GGA ar � • <br />