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FEE WORKSHLET PER E CH FACILIT. <br /> FACILITY r <br /> DBA r ADDRESS <br /> MAILING ADDRESS <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 /> (# Temporary closures x $80) (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 intWk Y m e�D <br /> R <br /> of re-using tank , <br /> (#_/_ Permanent Closures x $90) FEB ? 4 <br /> 5. Plan Check Fee $30. MENTAL MALTµ <br /> ENVfRQN <br /> PERMITISERVICES <br /> Total dumber of Tanks Total Fee DueQ <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> �l {�'3 t <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, I unleaded, 1 supreme, I 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 �v , <br /> *doth closures will be conditioned. Contact a Health District Re resentative_ <br /> 2 <br /> -7- <br />