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FEE WORKSHM PER EACH FACILITY FACILITY <br /> DBA �.� ADDRESS N <br /> MAILING ADDRESS 5 <br /> 1. operating Permit Application/Annual inspection Fee <br /> a, First Tank at Facility @ MO. <br /> b. Additional Tanks (I _ Additional Tanks x S50) <br /> 2. State Surcharge (per tank) (Due with Permit Applications <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 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 #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, <br /> {f �Permanent Closures x ~ ) PLPeU:, S - �-1'�35.0� ``�z V <br /> !►�Sv�CT1 {,l Hid. �tI vrtLL+M- <br /> 5. Plan Check Fee $30. � <br /> 4 <br /> Total Fee Due ('0 <br /> Total Humber of Tanks <br /> r <br /> Make all feespayable a able to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> l ) <br /> (1 regular. I unleaded, ] supreme, 1 waste oi $150 <br /> 1a. Existing Facility b 1st Tank 150 <br /> b. 3 Additional Tanks x $50 <br /> 4 Tanks x S56 224 <br /> 2. State Surcharge, <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br />