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FEE WORKSHEET <br /> DBA L CA l_o N C F"J-1 E-iZ�ZN 4!il�Z i C + C 8:'-kAL.-'1 a'0 C�PHE �_../7 V 7 <br /> ADDRESS C,4lo'i <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. -- <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> or renewal or amendment of operation permit) <br /> ($56 x Total = Tanks) <br /> a. *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) <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) AFL) <br /> Total Number of Tanks Total Fee Due �J <br /> Q� <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> oji th 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 & 1st Tank $150 (� <br /> b. 3 Additional Tanks x $50 150 " �tIl <br /> 2. State Surchar e 4 Tanks x $56 224 <br /> 9 ,_ FEES 25 !ydb <br /> Total Number of Tanks -4 Total Fee Due $524 ENVIROM Et4TAL HEALTH <br /> FERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 1-86 <br />