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FEE NORKSHCET PER EACH FACILITY • . <br /> FACILITY <br /> DBA 4 ADDRESS <br /> MAILING ADDRESS RC1 ZT_f(i <br /> 1. Operating Permit Application/Annual Inspection Fee 6 <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (f 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 /> (156 x Total f Tanks) �� Z <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 /> (f_ 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 . / Fri <br /> (f Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> -44 C , <br /> Total Number of Tanks �— <br /> (9 s 7 ` /ota//n^1 .^' /�// <br /> � <br /> 1�F a Due — <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. PAYMENT <br /> RECEIVED <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> AUG 2 G 1987 <br /> ( I regular, 1 unleaded, 1 supreme, 1 waste oil ) ENVIRONMENTALNRVICESLTH <br /> Ia. Existing Facility 6 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 C �� -/3G 5 <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 Health District Representative. <br /> 2 -.;G <br />