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FEE WORKSNCET PER EACH FACILITY - <br /> 06A PAOW WCLSvk FACILITY <br /> A; J <br /> D�DARESS /705 CdMCdAIeX MA,yrFc.� C4A <br /> MAILING ADDRESS 300 bji/E1� GZe-ti NAeLMIN7 eh QSfO/Z <br /> 'r;4 t3 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ 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 /> (f56 x Total f Tanks) <br /> `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 0 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 intentm E N T <br /> of re-using tank _ RECEIVED <br /> �v i <br /> (f� Permanent Closures x $90) p;;;,; !. = 15 ' <br /> 91) <br /> S. Plan Check Fee $30. ENVIRONMENTAL HEALTH., <br /> M PERMITISERVICES <br /> �v <br /> Total Number of Tanks / Total Fee Due <br /> Make all fees oavable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( i regular, I unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility b lst Tank $ISO <br /> b. 3 Additional Tanks x $yn 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 -x6 <br />