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FEE WORKSHLLT PER EACH FACILITO p1,,0b <br /> FACILITY <br /> DBA CFIUTt o ADDRESS <br /> MAILING ADDRESS j9rj J30 ? C LO Di C!q <br /> 1 . Operating Permit Application/Annual Inspection Fee NOV 1 Inlytlb <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (d Additional Tanks x $50) ENVIROMENTAL HEALTH <br /> PERMIT/S RVICES <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 H 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 $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 . RECPAYE VED <br /> 0 .3 Permanent Closures x $90) a07GrG <br /> 5. Plan Check fee $30. <br /> NOV � 819SF <br /> ENVIPO MMiLTH <br /> SERVICES <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 /> ( 1 regular, I unleaded, l supreme, I waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 <br /> h. 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 /> *Both closures will be conditioned. Contact a_ Heal_th District Representative_ <br /> 7-86 <br /> Ut;-7 al <br />