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rtt WURKSHLLI PER EACH FACILI*,W <br /> DBA j C h !C ADDRESS Y Z53'43 _ �GrmlrGuJw <br /> MAILING ADDRESS I�,Q. (�C3X a ] 1-arv✓iiit�rU CA RSZ3d <br /> i <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. ISO <br /> b. Additional Tanks (M_L Additional Tanks x $50) Jro So S(D <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 c�- Tanks) I I <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 /> (N_ Temporary closures x $80) (See above N3 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 /> (d_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. J/ /--�— <br /> aop <br /> Total Number of Tanks — Total Fee Due `7 <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 /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. 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 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> OTT- a1 <br />