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FEE WORKSHCET PER EACH FACILITY , <br /> QQ FACILITY ® // <br /> DBA iL���L�C �/ci �l�r�z DRESS SOS lil�i� cam_ -leppe� <br /> MAILING ADDRESS G/ 6wiXC �C, <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (M 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 N 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 owner/operator has no intent <br /> of re-using tank , <br /> (N / Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <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 /> PAYMgNy <br /> REC(1:IVgID <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> MAR � p 1897 <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility b 1st Tank $1.OVIRONMENTAL HEALTH <br /> b. 3 Additional Tanks x b50 150 PERMIT/SERVICES <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 /> 2-:;G <br /> IACs1 � f <br />