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YLL NOROHLLI PER EACH FACILITY <br /> �� FACILITY <br /> DDA- <br /> > L ADDRESS <br /> MAILING ADDRESS <br /> acr Lor.PT�C� <br /> I. Operating Permit Applicatiu /Annual Inspection Fee <br /> a. First Tank at Facility P $150. <br /> b. Additional Tanks (M/ Additional Tanks x $50) A r <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) !/:X- <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 /> (M_ 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 , PAYMENT <br /> (N_ Permanent Closures x $90) RECEIVED _ <br /> 5. Plan Check Fee $30. DEC 2 9 1988 — <br /> ENVIRONMENTAL HEALTH <br /> pEPMITISERVICES <br /> Total Number of Tanks ;�� Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> -"Yith your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded , I supreme, 1 waste oil ) <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 /> -losures will be conditioned. Contact a Health District Representative. <br /> 1 . ..i <br />