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FEE WORKSHEET PER EACH FACIL& <br />� FACILITY <br /> � ..� , a �(wIC� ADDRES .�,S1 L, �U . ��rY. 33 ` � � �1( I✓l�ll <br /> DBA I'F I- �i <br /> MAILING ADDRESS r) 'S Cl1e �r.P <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. - <br /> b• Additional Tanks (# I 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 # _ 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 intent <br /> of re-using tank , ,cl <br /> (# Permanent Closures x $90) !� •�^o <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 /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <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 n <br /> *Both closures will be conditioned. Contact a Health District Representative. f a <br /> 2-86 ✓��584 <br /> UGT a1 <br />