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FEE WORKSHEET PER EACH FACIL <br /> FACILITY E•tlC��h1 E 1l <br /> DBA _ _ T-Y n p' STcx T~� ADDRESS /21I E, 5w 1J <br /> MAILING ADDRESS Cl �-5/ rJ �4 _ 2�m 312 --- <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. /SD <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) Underxground 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. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks 1 Total Fee Due 2 4 <br /> V.,ke all fees payable to San Joaquin Local Stealth District_ Enclose this worksheet <br /> -;i Lh your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank <br /> b. 3 Additional Tanks x $50 <br /> p <br /> 2. State Surcharge, 4 Tanks x $56 274 MAR 2 8 198b <br /> - <br /> Total Number of Tanks 4 Total Fee Due SVIR4}MENTAL HEALTH FERn.W/SERVICES <br /> *Both closures will be conditioned. Contact a Health 'District Representative. <br /> 2--86 <br />