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FEE WORKSHEET PER EACH FACT* <br /> DBA FACILITY /J <br /> ADDRESS j M� <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P 5150. <br /> b. Additional Tanks (d Additional Tanks x $50) <br /> 2. State Surcharqe (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation Permit and temporary closure) <br /> (S56 x Total N Tanks) <br /> 3. 'Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (r_ Temporary closures x S80) (See above /3 to calculate surcharge) <br /> 4 • "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operatorP T$_W nit <br /> of re-using tank , MT <br /> RELIVED <br /> (N / Permanent Closures x $90) <br /> 5. Plan Check fee 530. MAY 9 i lbao <br /> ENVIRONMENTAL HEALTH <br /> PERMITJSERVICES <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 /> n <br /> r/ <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 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 5524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> Z-..L <br />