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NaH(:NRNE�y <br /> FEE WORKSHEET PER EACH FACILlit <br /> FACILITY +iAPNEY M IJC LAIJPFIU; <br /> DBA ADDRESS "VE LD DZ 7 CA <br /> MAILING ADDRESS <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. ` / p <br /> b. Additional Tanks (#_0 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 /> ($56x 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 /> 5. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage h2s- Ceased and where the owner/operator has no intent <br /> of reusing tank within next 2 years. puk obore r��^� o✓ g <br /> r,ePt�u.ed.:�w�fh �0V8 oJ/dv11Dl.� -�' <br /> (#_ Permanent Closures x $90) <br /> Total Number of Tanks / Total Fee Due 4,— <br /> 3-ob <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 /> la. Existing Facility 6 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 condit` ned. Contact a Health District Representative. <br />