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FEE WORKSHEET FOR EACH A <br /> CILITY <br /> DBA <br /> FACILITY ADDRESS <br /> MAILING ADDRESS � .'�) AA <br /> 1 . Operating Permit Application/Annual Inspection Fee Crnx, S-3CwX <br /> a. First Tank at Facility @ $150 . _ <br /> b. Additional Tanks ( # Additional Tanks x $50 ) J <br /> 2 . State Surcharge (per tank) ( Due with Permit Application <br /> on renewal or amendment of operation permit and temporary <br /> closure. ) <br /> $56 x Total # Tanks ) <br /> 3 . *Temporary Closure (per tank) Underground Storage Tank in <br /> which storage has ceased but where the owner/operator pro- <br /> poses to re-use tank within two ( 2 ) years . <br /> # Temporary closures x $80 . (See above #3 to calcis- �- <br /> late surcharge) c Y <br /> 4 . *Permanent Closure (per tank) Underground Storage Tank in <br /> which storage has ceased and where the <br /> no intent of re-using tank. <br /> ator has <br /> # .73— Permanent Closures x $90 RECEIVED <br /> fh( <br /> 5. Plan Check Fee: $30 . 00 DEC 1 1988 <br /> DWIRONMENTAL HEALTH <br /> TOTAL NUMBER OF TANKS FERMIT15fR-V <br /> FEE DUE ;~ <br /> Make all fees payable to: San Joaquin Local Health District <br /> Enclose this worksheet with your check. <br /> EXAMPLE: Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 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 /> ll' <br /> *BOTH CLOSURES WILL BE CONDITIONED. CONTACT A HEALTH DISTRICT REPRESENTATIVE. <br /> EH 23 032 2/$6 • <br />