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FEE MORKSHLET PER EACH FACILITY • <br /> FACILITY <br /> DBA ftVA rIUL)(r ADDRESS <br /> MAILING ADDRESS �R <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> d <br /> 2. State Surcharge (per tank) (Due with Permit Applications <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 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 /> (f_ 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 /> 3O.Oz� <br /> (f_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. 22 <br /> PIPF�uNG �o�srRu�rle-,.� �.�6:Oa Pic-lieuf� P'C�- tr�SP&�z�� `q <br /> Ff::6- yUiutnww.- 1 tiJSOE �ZoIJ. <br /> Total Number of Tanks 3 FP19- QCPi�12- ttt��uc> ee , <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. 1 unleaded, 1 supreme. 1 waste oil ) <br /> Ia. Existing Facility 6 lst Tank $150 <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 District Representative. <br /> ;' 2-R6 . • <br />