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FEE WORKSHEET PER EACH FAC1L.,— FACILITY <br /> DBA <br /> F .M.C. ADDRESS 5161 P7. BUSINESS LOOP 20 <br /> MAILING ADDRESS 0• <br /> R. Barney Strong, 33 Holl ood Ave. Trac Cali <br /> 1. <br /> HIS LOCATION <br /> New Facility or Addition <br /> (NO UNDERGROUND TANKS AT T <br /> a. First Tank $180. <br /> b. Additioua-1 Tanks (# Additional Tanks x $50) <br /> 2• Operating Permit Application/Annual Inspection Fee - <br /> a. Existing Facility and 1st Tank @ $150. <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 /> ($5s -- Total # 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 /> S. *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 _ Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> r:ith 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 & 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 />