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FEE WORKSHEET PER EACH FACILITY <br />\_J <br />FACILITY <br />W Scan -Cats Sgj,u &, .Luc. ADDRESS %O// <br />MAILING ADDRESS /0// e�7, Z'`/NOs�I✓ ST, <br />1 <br />02 <br />�3 <br />4 <br />5. <br />New Facility or Addition <br />a. First Tank $180. <br />b. Additional Tanks (# <br />Additional Tanks x $50) <br />Operating Permit Application/Annual Inspection Fee <br />a. Existing Facility and 1st Tank @ $150. <br />b. Additional Tanks (# �1_ Additional Tanks x $50) <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary closure) <br />($56 x Total # Tanks) <br />*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 />*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 within next 2 years. <br />(# Permanent Closures x $90) <br />Total Number of Tanks Total Fee Due <br />_ x/11 <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet �1� <br />with your check. <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, <br />Ia. Existing Facility b 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />1 waste oil) <br />$150 <br />150 <br />Total Fee Due $524 <br />*Both closures will be conditioned. Contact a Health District Representative. <br />2-86 UGT 21 <br />