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FEE IIORKS11r[T pER��ACH <br /> FACILITY <br /> DBA ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $ISO. <br /> b. Additional Tanks (I 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 / 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 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 /> ofre using tank , a a <br /> (I7 Permanent Closures x $90) U <br /> 5. Plji"Check Fee $30. <br /> i <br /> Total Number of Tanks 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. I unleaded, 1 supreme, 1 waste oil ) I <br /> Ia. Existing Facility 6 1st Tank 5150 / 1 a <br /> b. 3 Additional Tanks x $50 150 14e'k <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Oue $524 L <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> Z -,iL <br />