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Af <br /> FEE WORKSHEET PER EACH FACILITY. / <br /> FACILITY <br /> DBA a_�' STr AOORESS <br /> MAILING ADDRESS 13 <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 /> ($56 x Total ! Tanks) <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which PAYMENT <br /> storage has ceased but where the owner/operator proposes to RECEIVED <br /> re-use tank within 2 years. SEP 2 3 1y�8 <br /> (!_ Temporary closures x $80) (See above !3 to. calculate surcharge) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which ENVIPERNMEN7AL HEALTH <br /> ERMITISERVICES <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank, <br /> (!/ Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due H ! <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check, C # /D/(p3 <br /> 7T <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility 8 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 /> EH 23 032 2/86 <br />