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FEE WORKSHEET PER EACH FACILITY �!3 tv 3 HW <br /> FACILITY <br /> DBA cSL ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 task within 2 years. <br /> (H_ Temporary closures x $80) (See above H3 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 _ <br /> (q_ Permanent ClositC� $90) d7'� <br /> "O <br /> Total Number of Tanks N�{��� tal F e <br /> �6Due/ <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> r <br /> with your check . <br /> E1'vwti,v: t:., y <br /> fizALTN <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ff_R(WI)%SERVICE$ <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. 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 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />