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rLL WURKSHLLI PER EACH FACILIT� • <br /> FACILITY <br /> OBA i/�0 �p c ./,1. 1,2,1 �47ge 'OADDRREESS �o <br /> MAILING ADDRESS��� So a ��/ /oc�C�°`? /��n r K <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 N 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 /> (B_ Temporary closures x $80) (See above N3 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 . G oc <br /> (q i Permanent Closures x $90) 9 <br /> 5. Plan Check Fee $30. <br /> G <br /> Total Number of Tanks Total Fee Due / 9� 0 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . <br /> Aq Y <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks R FCF V N T <br /> ( 1 regular, 1 unleaded, I supreme, 1 waste oil ) j G 9 <br /> Ia. Existing Facility 8 1st Tank $150����RO/yME j B8 <br /> b. 3 Additional Tanks x $50 150 PEST/FRV/` y��T <br /> 2. State Surcharge, 4 Tanks x $56 224 CES f/ <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-B6 <br />