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FEE NORKSHCET PER EACH FACILITY <br />F AC I L I TY <br />DBA �' (� ADDRESS <br />MAILING ADDRESS L /� �cc �� l� �J <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. SSD <br />b. Additional Tanks (N 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 />(S56 x Total b 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 />(I 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. <br />(N Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks Total Fee Due <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet S <br />with your check. 3 p <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, 1 waste oil) <br />Ia. Existing Facility b 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 <br />Total Fee Due $524 <br />*doth closures will be conditioned. Contact a Health District Representative_ <br />? - t;G <br />