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=E`. wORKSHLLT PER EACH FACILITY <br /> FACILITY <br /> DBA �S I�J1� ��' ADDRESS �60S- <br /> 4AILING ADDRESS Fop S <br /> �l98b- /1'� i9Y��{o i4ad-/sv <br /> 1. Operating permit Application/Annual inspection Fee fo S-00-0 <br /> c� <br /> a. First Tank at Facility @ S150. f-42on'a Zon l�Z <br /> b. Additional Tanks (/ `L Additional Tanks x $50) 31-L,0-F <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 x Total N 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 13 to calculate surcharge) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the gwner/operator has no intent <br /> of re-using tank , C20- <br /> (#__L--Permanent <br /> zJ(/__L--Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> dJ <br /> Total Number of Tanks � Total fee Due <br /> /,off <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 /> la. Existing Facility 6 1st Tank 5150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x SS6 224 <br /> Total Number of Tanks 4 Total Fee Due SS24 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-26 <br /> Un7 � l <br />