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FEE WORKSHEET PER EACH FACILITY* <br /> TY <br /> DBA � of ADDRESSSCO ZfE A-V ► �7-� <br /> MAILING ADDRESS ' :3 '333 S'�,�u� S7 <br /> 7/ <br /> 1, Operating Permit Application/Annual Inspection Fee ' ell <br /> pp <br /> a. First Tank at Facility @ MO. <br /> b. Additional Tanks (N t4N Additional Tanks x $50) la d /00 /�d <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) 2 <br /> ($56 x Total # 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 /> (N Temporary closures x $80) (See above I3 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 , <br /> (I! Permanent Closures x $90) PAYMENT <br /> RECEIVED <br /> 5. Plan Check Fee $30. <br /> jUL 12 1988 <br /> ENVIRONMENTAL HEALTH "`' <br /> Total dumber of Tanks <br /> PERMITISEIMICIESFee Due l <br /> Q,�-- 'A �va3 <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, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 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 $524 <br /> "Both closures will be conditioned. Contact a Health District Representative. <br />