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FEE WORKSHEET PER EACII FACIl�Y � � (Of-4 14,x) <br /> DBA FACILITY <br /> ADDRESS <br /> tA NGVRS 4mi <br /> loln,k RVW- fMC4+ <br /> I. Operating Permit Application/Ann�l Inspection Fee <br /> a. First Tank at Facility @ $150. PAYMEt4T <br /> b. Additional Tanks (N Additional Tanks x $50) ftE C E1V E D <br />' 2• State Surcharge (per tank) (Due with Permit Application, JUN 9 1988 <br /> on renewal or amendment of operation permit and temporary qMKC04MENTAL HEALTH <br /> ($56 x Total A Tanks) pERMITISERVICES � <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 tq 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 /> of re-using tank . <br /> (# Permanent Closures x $90) t96 <br /> 5. Plan Check Fee $30, <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Focal 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 /> Ia. Existing Facility b 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- R.esentative. <br /> 86 <br /> .l.l r1-T n 1 <br />