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FEE WORKSHEET PER EACH FACILITI <br /> _ icic ( CC° pir ,g FACILITY <br /> DBAlZ3U S , G� C�{, �bGL( <br /> // ADDRESS , <br /> MAILING ADDRESS <br /> 3 Tiu,.l�s 86 $�T xk <br /> I. Operating Permit Application/Annual Inspection Fee /Sb& !S-b rSO� <br /> a. First Tank at Facility @ $150. l _ Ile <br /> b. Additional Tanks (/ � Additional Tanks x $50) �OCrCTboo <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total N_S Tanks) «go <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 /> (/_ Temporary closures x $80) (See above /3 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 ,2?D <br /> 0 3 Permanent Closures x $90) RECEIVED <br /> 5. Plan Check Fee $30. JUN 231988 <br /> ENVIRONMENTAL HEALTH eo <br /> Total Number of Tanks 3 P"R bTMRYLgSDue �,��� <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, I 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 /> `Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> 0cI � r <br />