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FEE WORKSHEET PER EACH FACT' <br /> / `'�B fACIEITY <br /> DBA in �lz,,�co�'u�+at ,Old - ADDRESS 617!/9 A',2 )0'66t-' � d'lo�oy <br /> MAILING ADDRESS s/eg <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (N Additional Tanks x $50) <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 Tanks) <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 03 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 /> (N_L— Permanent Closures x $90) <br /> S. Plan Check Fee $30. ^� /JP,�Cf <br /> Total Number of Tanks Total Fee Due <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 /> ( I regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia . Existing Facility 8 1st Tank $150 <br /> b. 3 Additional Tanks x S50 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-ff, <br /> e resentative.2-ff, <br /> 007 <br />