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FEE uORKSHCET. PER-EACH FACILITY <br /> 06A C OA/4T FACILITY <br /> ADDRESS 0`L"1SO,f! S <br /> MAILING ADDRESS p iF jG <br /> Ci a� eyj�ellpn <br /> 1. Operating Permit Application/Annual Inspection Fee 790 <br /> 7900 l�Vran ^o� <br /> a. First Tank at Facility P $150. <br /> b. Additional Tanks (I Additional Tanks x 150) QfS C'�0 953b1 <br /> 2. State Surcharge (per tank) (Due with Permit Application. <br /> on renewal or amendment of operation permit and temporary closure) <br /> (156 x Total / 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 /> /._ Temporary closures x 180) (See above I3 to calculate surcharge) <br /> G *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent ENT <br /> of re-using tank , PAGEXvE0 <br /> (lam Permanent Closures x $90) RE �`1 el 7o OD <br /> 5. Plan Check Fee $30, H <br /> h�` � ENTP�NEA ' <br /> �t <br /> A �r1Vl P�RMZ)SERVICES <br /> Total Number of Tanks �� Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet W 76) <br /> with 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 S 1st Tank $ISO <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 /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> 2-1:G l <br />