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FEE WORK-SHEET PER EACH FACILID 0 <br /> FACILITY <br /> DBA `," s ADDRESS <br /> MAILING ADDRESS <br /> I . Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ S150. <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 /> 056 x Total N Tanks) t <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 /> (P_ Temporary closures x S80) (See above /3 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 Lanka <br /> 0 Permanent Closures x S90) <br /> PAYMENT <br /> 5. Plan Check Fee $30. RECEIVED <br /> MAY 3 1 196d <br /> Total Number of Tanks EWWW T4 HEALTH X50 <br /> - — i PERMITISERVICES <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, i waste oil ) <br /> Ia. Existing Facility 8 1st Tank 5150 <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 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-80 <br />