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, tr K Ft ET .PER '.EACH FACt I <br /> i NCi ADDR S ' `► 'r ' �� .a J t�' + » 'aL <br /> -I. operating Pe it ,Applcaton/Annual Inp ° on Fee <br /> a., FirstTank at­Faeili y t $151. <br /> nkbAlditioral a . <br /> State Surehargep+er tank}; (Due wi=th Permit Application, <br /> onor a nd nt of cfipera�tion':P it ��a �t �orary closure) <br /> Tanks) <br /> 3- : 'Temporary, Closure (:per tank) Undergraur4d Storage 'Tank, n which <br /> -storage has ceased but' where ;the ower/operator propbses to <br /> re se :talk within 2 years. <br /> ;closures =x $961 (See ab v* 3 to cat 41,ot surcharge) <br /> ° » Permanent Closure (per tank) 1tr'#er,g,' v 'Stora Tank in which <br /> torage 'has ceased end"where ;the owner/operator has no intent <br /> of re-using tank, <br /> Pe rent Ci asur+ s x $90 i <br /> 5. Plan Cheek Fee $30. W • <br /> Total Number ofank�s : Total Fee Due <br /> 'Ma ke all fees payable to San doac41n; vocal Health District. Enclose=this worksheet <br /> ria th your check, <br /> EXAMPLE - ,Annual Fee for Facility,,,with 4 Tanks <br /> (I regular,, l unleaded, I supreme,, I waste 'oil ) <br /> la Existing; Faci l fty":& Ist Tank $150 <br /> b. '3'Addttfonal, Tanks°,,, x $$0 150 <br /> 2. State Surcharge, 4. "Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures wiTl be conditioned;: Contact a HealthDistrict ,Rep sentativ-e., <br /> 2-66, <br /> r <br />