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FEE W k6K tE_ <br /> rI.} .J h owe <br /> :. <br /> wrfw <br /> ADDRESS ' <br /> «1 0peratzng Pernft Applzcatzon/Annual Inspection Fee Y <br /> ti { <br /> xzsti.ng <br /> a �:E _,Eaci --ty and Ist Tank @ .$150, t <br /> b z.;AddztionaT:Tank`s-`(# ^- additional Tanks x:$50} , } <br /> 2. State Surchar L-" ,er tank Due with. Permit A Ti.catsdn ='= <br /> ... - .:..1._. - <br /> •. on renewal or-amendment of operation .permits _` -•��- . - <br /> :t 1 <br /> 3 *Temporary Closure• per tank} Underground Storage.Tank in which <br /> f_7 r j '? �' .:. -<...,._;.'... .: � - ` ♦ .h Y t . <br /> storage has, but where--the owner/operator-:'proposes .to '- - f - <br /> s re use tank wzthzrt`2 years <br /> _(j empor`ary closures <br /> < 4. *Permanent Closure (per tanks Underground Storage Tank--in which .,� <br /> :. <br /> r <br /> storage has ceased and where'the ownerioperator has. no intent rt <br /> sG k of re usz.ng stank within .next:2.years ; <br /> y"t.r. <br /> - <br /> } , ( _L Permanent Closures x $9Q} <br /> L <br /> TotalNumber of Tanks Total Fee 'Due ,B� <br /> Make all fees payable to San `Joaquizn`LocalHealth District.' -Enclose this ii&.- sheet f ' <br /> tfwz th our check and thercompl eted app1 i cati on _� <br /> ey ••ty' ' L^_.a. '=s �"`. i r ;S♦ 1• -� _mow { _ c� _ ' r'- -�-- <br /> 4. <br /> �._�I,t--�, � �� s t-•• y r�''�`. +}a,Y. 4 t t 1 .� �f -I ,cS 7 ? ..r Y -3 4 K<. 'lf�'< _ 1 .• �; <br /> EXAMPLE Annual Fee for Fad ty with 4 Tanks <br /> � r <br /> (I regular, 1 unleaded, 1~supreme, A waste oil-.)*--* <br /> a +T 3 _w alt• y c } <br /> Exz stz ng Fac-ft' ty & Ist Tanks• <br /> ti Px `�.--.. ; { , Y: t2<i-�;.- *•i it •X ��.L,t', �t,y, : iltt �-r.�. <br /> :NK . .., �.: - 6�= 3,Addz tz onaT Tanks x' <br /> $50 i ny` ;15a <br /> k .>. �• ti .. a• s r-_ i n��ty�A`:� S - f � ri �' <br /> t }w <br /> +State Surcharge, ,� Tanks x �y'� <br /> .'*•s'`A••l+�'. y� <br /> � ..�� ¢� <br /> �`t} Total:.Number ofTanks 4 - t� Total Fee Due 5 4 ` <br /> *Both closures wi1.1 be conditioned. Contact a Health District Representative6 <br />