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*FEE W` SHLETPER EACH FACiL <br /> r R t 341 EAST MAIN <br /> OBA KIENSER SHELLFAC 1 L t TY <br /> ADDRESS RlPWf CA 95366 <br /> e <br /> MAILtN6 A00RESS 341 EAST MAIN, RIPON, CA 95366 <br /> L Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. N/A <br /> b. Additional Tanks (/ Additional Tanks x $50) N/A <br /> 2, State Surcharqe (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total N Tanks) N/A <br /> 3• 'Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where theowner/operator proposes to <br /> re-use tank within 2 years. <br /> (M____ Temporary closures x $80) (See above N3 to calculate surcharge) N/A <br /> 4• *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent f <br /> of re-using tank , � <br /> PAYMENT <br /> 0 Permanent Closures x $90) VtErEIVED N/A <br /> 5. Plan Check Fee $30. FEE 4 lug.; $30.00 <br /> ENVIRONMENTAL ERVV�E <br /> Ee <br /> �LTH <br /> Total Number of Tanks EXISTING; <br /> Total Fee $30.00 <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, I unleaded, l supreme, 1 waste oil ) <br /> Ia. Existing Facility 6 1st Tank S1SU <br /> b. 3 Additional Tanks x $50 1,0 <br /> 2. State Surcharge. 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due W4 <br /> 'both closures will be conditioned. Contact a Health District Representative. <br /> 2-t:G <br />—1467- <br />