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FEE WORKSHCET PER EACH FACILITY <br /> FACI L I TY <br /> DBAWW ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ S150. <br /> b. Additional Tanks (0 Additional Tanks x $50) _ <br /> 2. State Surcharqe (per tank) (Due with Permit Application, <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 /> (/ Temporary closures x $80) (See above N3 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 /> (# / Permanent Closures x $90) 9 PAYMENT <br /> RECEIVED <br /> 5. Plan Check Fee $30. <br /> SEP 29 1988 <br /> IfNVIRONME �I <br /> Total Number of Tanks PERM " � t ue <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheel <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 $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 5524 <br /> `doth closures will be conditioned. Contact a Health District Representative. <br /> 2-: 0 <br /> C'_7. r <br />