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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DBA M0,1I ljj� J-Od� Qe„�,�1 ADDRESS 1095 U3 <br /> MAILING ADDRESS 92C C�NGrA-Cf Lick Sk'6ck �^ <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P $150. <br /> b. Additional Tanks (0 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 1 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 owner/operator has no intent <br /> of re-using tank . PAYMENTab 00 <br /> (lam Permanent Closures x $90) RECEIVED Js <br /> 5. Plan Check Fee $30. J ui 29 1988 <br /> ENVIRONMENTAL HEALTR C <br /> Total Number of Tanks PERMIT/SERVICES Total Fee Due <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 & 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-RG <br /> OC-1- r <br />