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'E['►ORK,SHIET PER EACH FACILITY <br />. . FACILITY <br />MONTGOMERY WARDS ADDRESS 5400 PACIFIC AVENUE, STOCKTON, CA 95207 <br />IL[Ni ADDRESS 39201 FREMONT BLVD., FREMONT, CA 94533 <br />N <br />14. <br />Operating Permit Application/Annual Inspection .Fee <br />a. First Tank At Facility Q $150. <br />b. Additional Tanks (I Additional Tanks x $50) <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and. temporary closure) <br />(156 x Total A Tanks) <br />*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 0 to calculate surcharge) <br />*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 />(1 4 Permanent Closures x $90) <br />15. Plan Check Fee $30. <br />Total dumber of Tanks <br />Total Fee Due <br />Make all fees payable to San .loa uin Local Health District. Enclose this worksheet <br />with your check. <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, I supreme. 1 waste oil) <br />Ia. Existing Facility & ist Tank 5150 <br />b. 3 Additional Tanks x $50 154 <br />2. State Surcharge, 4 Tanks x S56 224 <br />Total Number of Tanks 4 <br />Total Fee Due $524 <br />*Both closures will be conditioned. Contact a Health District Representative. <br />360.00 <br />30.00 <br />390.00 <br />