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FEE WORKSHCET PER EACti FACILITY <br /> IFC <br /> y <br /> ` tF CILITY <br /> DBA ' : bV5ADDRESS <br /> MAILING' ADDRESS <br /> -r4W <u;rrO <br /> ' 1. : Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (l�_ Additional Tanks x $50) o <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 I 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 /> (1' Temporary closures x $80) (See above 13 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 /> (1' Permanent Closures x $90) ! <br /> S. Plan Check Fee $30. <br /> Total Plumber of Tanks 1 Total Fee Due <br /> Macke all fees payable to San Joaquin Local Health District. Enclose this workshee <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility b 1st Tank 5150 <br /> b, 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 PAYMEr,4-r <br /> �EC,EIVED <br /> Total dumber of Tanks 4 Total Fee Due $524 <br /> ENVIRONMENTAL <br /> PERMIT/SERV! HEALTH <br /> *Both closures will be conditioned. Contact a Health District Representative. CES <br /> 1-fits <br />