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FEE WORKSHEET PER EACH FACILITYFACILIT �l <br /> OBA ��{1}^nt- y c (Do PeA-- 4 � <br /> ADDRESS �USy1/L✓ ' `u t � Gl/y . <br /> MAI'! IING ADDRESS �� G� C� S//2 <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <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 /> ($56 x Total N 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 /> (!_ 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 qwner/operator has no intent <br /> of re-using tank . v 0 <br /> (lam_ Permanent Closures x $90) P AY M E NT <br /> 5. Plan Check Fee $30. RECEIVED <br /> AU G 1 G 1988 <br /> Total Number of Tanks FNVIR0NMENTACl4WTl>1ee Due <br /> PERMITISEWCES <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, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility R 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x 556 224 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> UC'7 --I J <br />