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FEE WGRK-SHEET PER EACH FACILITY �/ <br /> / FACILITY � E ��i LENS MA7-W <br /> , <br /> DBA I �z.,��� Als- N?/IX4ADDRESS <br /> MAILING ADDRESS '/.e ,Ce T< ��t�ot �FfL � S7OCkL-0 �, �� Z07 <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 /> ($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 13 to. calculate surcharge) <br /> L?. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> PAYMENT <br /> of re-using tank , RECEIVED <br /> (1_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. SEP 29198a L <br /> ENVIRONMENTAL HEALTI-) e o <br /> PERMITISERVICES y= <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 /> ( I regular, 1 unleaded, 1 supreme. 1 waste oil ) <br /> Ia. Existing Facility 8 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 /> EH 23 032 2/86 <br />