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1�ElU�0�0 <br /> FEE WORKSHEET PER EACH FACILITY �j <br /> DBA �� �° ADDRESSY O OO S' It) <br /> MAILING ADDRESS <br /> 1. Operating Permit /9db- Ko r9y�!{o fgxt- is'o <br /> pe g Application/Annual Inspection Fee So rO <br /> 65 <br /> a. First Tank at Facility @ $150. rf 2no°` 200'- 712 <br /> b. Additional Tanks (/ "L Additional Tanks x $50) <br /> o, <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 B_7,,, 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 N3 to calculate surcharge) <br /> 4• "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the 9wner/operator has no intent <br /> of re-using tank , OC2v <br /> (I__2ePermanent Closures x $90) <br /> 5. Plan Check Fee S30. <br /> dJ <br /> Total Number of Tanks Total Fee Due 0� _ <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check, <br /> SEG <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks 19ga <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) PUG J HEPE�K <br /> Ia. Existing Facility E 1st Tank $150 �Nv\W0X4tj tg ICES <br /> b. 3 Additional Tanks x $SO 150 PERM <br /> 2. State Surcharge, 4 Tanks x E56 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 /> UGC � � <br />