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IEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DBA SToollciy A14oieAL CfiHFTE / ADDRESS SND aFCE.NCTPCk/ ��Nt'. 57oc ('roN C-ri- <br /> `tAILIN6 ADDRESS pp, ? </ / S 'IFeA-70cN r,4 M2 o / <br /> 1 . Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ Sm. <br /> b. Additional Tanks (/ 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 /> (156 x Total A 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 /> (f_ Temporary closures x $80) (See above 13 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 . PAYMENT <br /> (lam Permanent Closures x $90) RECEIVED qQ <br /> 5. Plan Check Fee $30. AUG 3 p 1988 <br /> PNVIRf1NMENTAL HEALTF4 <br /> PERMITISERVICES <br /> Total Number of Tanks QA( E Total Fee Due SAO. <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 /> ( I regular. 1 unleaded, 1 supreme, I waste oil ) <br /> Ia. Existing Facility 6 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 /> 'Both closures will be conditioned. Contact a Health District Representative. <br />