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FEE NORKSHLET PER EACH FACILITY <br />DBA I,O T K4 .1 FACILITY <br />MAILING ADDRESS 5� <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $I So.--7ANIc-#,4 �7 —7 <br />so <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 />($56 x Total NTanks) & <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 03 to 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 />(/ I Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks Total Fee Due�j <br />i <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 />0 regular, 1 unleaded, 1 supreme, 1 waste oil) <br />la. 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 <br />Total Fee Due $524 <br />*Both closures will be conditioned. Contact a Health District Representative. <br />x <br />c <br />2 -RG <br />I <br />