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FLL WORKSHLL1 PER EACH FACILIT Y40 <br /> FACILITY c! �l <br /> DBAv /�vw"�� Cc ADDRESS Z5�10-1 ti <br /> MAILING ADDRESS L ��yy �� 1� L� C-" <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 /> ($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 /> (N_ Temporary closures x $80) (See above R3 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 , <br /> (H� Permanent Closures x $90) --101v <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks 0'`-N-14-3 Total Fee Due ' Ct O oa <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> PAYMENT <br /> RECEIVE �� <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks MAY 19 19b <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ENVIRONMENTAL HEALTH <br /> la. Existing Facility & 1st Tank $150 PERMITiSERVICES <br /> b. 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, Health DistrictRepresentative. <br /> 2-86 <br />