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FES woRKSHEET PER EACH FACILITY <br /> & FACILITY <br /> De•A' /' t (L�� �Q� tQ+a� L ADDRESS l3Y S- <br /> MAILING ADDRESS �i' y o SfOC�Li7t1 Cr.�u �lt](J <br /> (�8ro reB� rqs z? <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. /$U /5� /S� <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 M / Tanks) <br /> S(o <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 /> (f_ 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 intent <br /> of re-using tank , 90 <br /> (N_L_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks / Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> scl6 CYJ <br /> with your check. <br /> PAYMENT <br /> RECEIVED <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks d 193 <br /> (1 regular, I unleaded, 1 supreme, I waste oil ) Q cT <br /> Ia. Existing Facility 8 1st Tank $150 ENTAL HEALTH <br /> >:NVIRONM <br /> b. 3 Additional Tanks x $50 150 PERMIJISERVICES <br /> 2. State Surcharge, 4 Tanks x $56 224 n (I ���q�:5 11 41 � <br /> Total Number of Tanks 4 Total Fee Due $524 IWWFV- <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> EH 23 032 2/86 <br /> • 0 <br />