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FEL WORKSHEET PER EACH FACIL@ 4- <br /> FACILITY <br /> DBA S cc a ADDRESS <br /> MAILING ADDRESS �a-r'4' _J L_�41�= �rrt 51 <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150, .1�Q <br /> b. Additional Tanks (# 1 Additional Tanks x $50) _50 <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # Af Tanks) 112- <br /> 4. <br /> 1Z4. *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 #3 to calculate surcharge) <br /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks 2 Total Fee Due 3/2 <br /> t�:lke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> Lh 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 & 1st Tank �Sala <br /> b. 3 Addito a <br /> i n 1 Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 7�! VAR Z 6 1986 <br /> Total Number of Tanks 4 Total Fee Due ERV4ROMENTAL HEALTH <br /> FERMIS'/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2--86 i <br />