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WORKSHEET PE.R EACH FACILITY <br /> FACILITY <br /> ADDRESS �� /�/������t� , s OaC*Tc�/ <br /> LING ADORFSs�3_ <br /> Operating Permit Application/Annual Inspection .Fee <br /> a. First Tank at Facility @ $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 /> (S56 x Total A—_, Tanks) — -- <br /> aT+tmporary 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 l3 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 /> oil re-using tank . A o0 <br /> (NLL Permanent Closures x $90) <br /> <\ - <br /> Plan Check Fee $30. '0No ��L 'i• __..______ <br /> F ``ti J"jd Fp <br /> 91 � <br /> Total Number of Tanks p/� TotW' e <br /> y <br /> ike all fees payable to San Joaquin local Health District. Enclose this worksheet <br /> ith your check , <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular. 1 unleaded. 1 supreme. l waste oil ) <br /> IA. Existing Facility 6 1st Tank $150 <br /> h. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge. 4 Tanks x 456 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> • <br /> t9oth viO ie corditiored. Cont.acc a iteal-i.i; bistrict Re resent4tid, . <br />