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J <br /> FEE WORKSHEET PER EACH FACILITY FACILITY Ec16'�6 Co <br /> DBA ADDRESS 1747 w• &22&29E �- <br /> MAILING ADDRESS Lj 4- <br /> 1. <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. /SO <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total #__,I _ Tanks) <br /> 4. *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 /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks 1 Total Fee Due 2 D L <br /> Q� <br /> Nnke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> -.; Lh 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 <br /> b. 3 Additional Tanks x $50 <br /> MHR <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> AE,N <br /> ViEAL <br /> Total Number of Tanks 4 Total Fee Due <br /> EWIRO /sem CTM <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 �.. <br />