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FEE WORK-SHEET PER EACH FACILI O 1 <br /> Q 7�— FACILITY d $^rpG �'Tort� �' d. <br /> DBA / d r-e71 S/ CSI �0 ADDRESS /613 <br /> ' 9.530 8 OOaS' <br /> MAILING ADDRESS <br /> �Go �' Sr c k tin Ca - <br /> 1. `Nac.1 .ty or Addition j C p Jia <br /> a. First an <br /> a - <br /> b. onal Tanks (# al 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 /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # Tanks) <br /> 4. *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) (See above #3 to calculate surcharge) <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. / 7 00' <br /> . <br /> (# 2, Permanent Closures x $90) 0 <br /> Total Fee Due <br /> Total Number of Tanks <br /> Joaquin Local Health District. e t worksheet <br /> Make all fees pay to San 9 <br /> with your the <br /> EXAMPLE - An or Facility with 4 Tanks <br /> (1 regular, 1 unlea a $150 <br /> Ia. Existing Facility & 1st Tank <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 /> 2-86 <br />