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FEE WORKSHEET PER EACH FACILITYFACILIT <br /> ADDRESSY I S.�CA.1TN I t.,t.o1 (?.t1 <br /> 08A �FSC�rkce�.� �� <br /> MAILING ADDRESS �d o <br /> 1 �8� I�S� 198 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 /> (S56 x Total # I 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 /3 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 , <br /> (NPermanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Fee Due <br /> Total Number of Tanks <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check _ PAYMENT <br /> RECEIVED <br /> SEP 14 1988 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> -- .ENVIRONMENTAL HEALTH <br /> ( 1 regular, 1 unleaded, I supreme, 1 waste oil ) PERMIT/SERVICES <br /> Ia. Existing Facility 8 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 ek. 1 109 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 I/1M1UIJlA� <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-M <br /> OC-1 at <br />