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FEE WORK-SHCET PER EACH FACILITY <br /> FACI L I TY <br /> OBA r f ADORES <br /> MAILING ADDRESS 5 <br /> Operating permit Application/Annual inspection Fee <br /> i' <br /> �. First .:lank at .Facility N USO. <br /> b Additional Tanks- (1-. 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 /> ($56 x Total 1 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.wlthin .2.years. <br /> (f „ Temporary `closures x $80) (See above D 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 /> {! LI Pertinent Closures x ) EMU0r✓S d��- - 00 f mtkou?L � •� <br /> k <br /> 5. Plan Check Fee $30. <br /> Total number of Tanks Total Fee Due �5 ? <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 /> (I 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 S56 224 <br /> Total Humber of Tanks .4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a health District Representative. <br /> Ztillt 1 <br />