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FEE <br />DBAAIr <br />WORKSHEET PER EACH FACILY' <br />Cirr,, ,�1� ! NC ADDRESSY <br />MAILING ADDRESS �C/ • %a(9� �%�. ��aQ� <br />I. <br />Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (#,Additional Tanks x $50) <br />_ <br />2. <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary closure) <br />($56 x Total k I Tanks) <br />3. <br />*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 />(N4(�K Temporary closures x $80) (See above M3 to calculate surcharge) <br />4. <br />*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 />(H�Permanent Closures x $90) <br />�/ <br />/.�, <br />Plan Check Fee $30. <br />_ <br />30 <br />Total Number of Tanks _L Total Fee Due <br />,::z G6• ° ° <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with your check. <br />x <br />2-86 <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(I regular, 1 unleaded, I supreme, 1 waste oil) <br />la. 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 />h closures will be conditioned. Contact a Health District Representative. <br />