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FEE wORK•SHCET PER EACH FACILITY <br /> FACILITY V2j­ } MTS <br /> DBA ADDRESS U 0 o �r, �• <br /> MAILING ADDRESS <br /> I:. ° Operating 'Permit Application/Annual Inspection Fee <br /> a. ; FirsV-Tank at. Faci]-Ity @ S150. <br /> bAdditional .Tanks `W, 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 /> (I Temporary closures x $80) (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/operator has no intent <br /> of re-using tank. C) o 0 <br /> (#..�L Permanent Closures x $90) <br /> 5. Plan Check rFee $30. ---— <br /> Total Humber of Tanks Total Fee Due <br /> Make all fees payable to San Joa uin Local Health District. _ Enclose this worksheet <br /> withY our check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> 0 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> 1a. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> c <br /> Z-86 <br />