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FEE uORK•SIIEET PER EACH FACILITY <br /> AC "Y <br /> 06A `dam A Q es ADDRESS <br /> NAILING ADDRESS 111 LQ ``�i" A <br /> 1. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ s150. <br /> b. Additional Tanks (I Additional Tanks x s50) <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 I Tanks) <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which <br /> PAYMENT <br /> storage has ceased but where the owner/operator proposes to RECEIVED <br /> re-use tank within 2 years. <br /> nEC � 1'� ? <br /> (1_ Temporary closures x s80) (See above I3 to. calculate surcharges <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which ENVIRONMENTAL HEALTH <br /> storage has ceased and where the owner/operator has no intent <br /> PERMIT/SERVICES <br /> of re-using tank. <br /> (i_ Permanent Closures x $90) <br /> 4 <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks <br /> Total Fee Due ° <br /> r Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check• t 4� L-LP <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> 6150 <br /> la. Existing Facility b lst Tank <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x 156 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2.110 <br />