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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY C A <br /> OBA to �" t So ` F� Qo ;lw . ~J` ADDRESS <br /> MAILING ADDRESS 5 a -- <br /> 1. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ S150. <br /> b. Additional Tanks (f 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 /> ($56 x Total f 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 /> (f_ Temporary closures x $80) (See above f3 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 . Qp`i�wEO 9( & <br /> Permanent Closures x $90) <br /> 5. Plan Check Fee $30. NAV 1� 4� yjN <br /> Igo.00 <br /> Total Fie Due <br /> Total Number of Tanks `- <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, i unleaded, 1 supreme, 1 waste oil ) <br /> $150 <br /> Ia. Existing Facility R lst Tank 150 <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x S56 <br /> 224 <br /> Total Number of Tanks 4 <br /> Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />