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0 <br /> FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DSA ADDRESS <br /> MAILING ADDRESS <br /> 1. ility or Addition ----------------- <br /> a. <br /> ----- ---a. F i rs t Tagk-R80z=--- _.___ <br /> b. itional Tanks (k Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (NAdditional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal ope -ation ermrit <br /> p and temporary closure) <br /> ($56 x Total # Tanks) Jh'°� <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 /> R Temporary closures x $80) (See above N3 to calculate surcharge) <br /> 5. *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 within next 2 years. <br /> (N_ Permanent Closures x $90) <br /> O® <br /> Total Number of Tanks J Total Fee Due �— <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet 46�/[!/ <br /> with your check. C/ <br /> EXAMPLE Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility 8 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 UGT 21 <br />