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° ,. <br /> FEE W^RKSHLET PER EACH fACILIiY TvC� <br /> � <br /> FACILITY <br /> DBA \`Qy Qott AOORESS 20&1 Clnw�a (y:y $ i � <br /> MAILING ADDRESS 2081 F . Gnorl�, Stk.. FfF� ' t 1q4 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (i Additional Tanks x $50) /8 6 <br /> 2. State Surcharge (per tank) (Due with Permit Application. I <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total A Tanks) L6 <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 i3 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 /> 00 <br /> (I Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> A <br /> Total Number of Tanks 7otai Fee Due `E( <br /> Hake 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, l unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility b 1st Tank 5150 <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 -a6 <br />