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FEE WORKSHLET PER EACH FACILITY <br /> 08A fZ(� FACILITY �x �u <br /> ADDRESS <br /> 'PIAILING ADDRESS ' <br /> 1• Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv p $150. <br /> Tom. <br /> b. Additional Tanks (d Additional Tanks x $50) ? <br /> 2. State Surcharge <br /> 9 (per tank) (Due with Permit Application, ` <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 x Total M 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 /> (d_ 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 owner/operator has no intent <br /> of re-using tank , <br /> (#_ Permanent Closures x $90) <br /> 5. Plan Check Fee 530. C <br /> �4��Inol� <br /> Total Number_of.. an s ` --..__ ___ c_9O <br /> - Total Fee�Due - -�_ <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br /> with your check_ <br /> PAYMENT PAYMENT <br /> RECEIVED RECEIVED <br /> E,. ;, <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks APR 1988 1988 <br /> 4 <br /> ( 1 regular, 1 unleaded, I supremENVIRONMENTAL EALTH ENVIRONMENTAL HEALTH <br /> FIEW!i}SERr S PERMIT/SERVICES <br /> la. Existing Facility 8 1st Tank SI50 <br /> b• 3 Additional Tanks x $50 150 <br /> 2. S[ate'Surcfiarge;'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 /> 4 <br /> 2-116 <br />