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NEW \}o �s <br /> FEE WORKSHEET PER EACH FACILITY <br /> 1 �j1 FACILITY lD <br /> DBA _ ' v '7 � �I5+rtr i ADDRESS <br /> MAILING ADDRESS � �M— <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. � �� <br /> b. Additional Tanks (/ 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 /> (S56 x Total N 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 /> (0— Temporary closures x $80) (See above 03 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 . q <br /> (/ ( Permanent Closures x $90) ` b <br /> 5. Plan Check Fee $30. <br /> 19 q <br /> Total Number of Tanks Total Fee Due �(e <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet �� <br /> with your check. S—� <br /> q <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular, 1 unleaded, 1 supreme, I waste oil ) <br /> la. 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 /> *Both closures will be conditioned. Contact a health District Representative. <br />