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FLE •WORKSHLET PER EACH FACILITO <br /> 11 AFACILITY <br /> - <br /> 06A ?. ADDRESS S #� c C y <br /> MAILING ADDRESS <br /> -„ <br /> I. Operating Permit Application/Ahnual lhtpection Pee <br /> a, First Tank at Facility @ $150. <br /> b. Additional Tanks (#---L 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 lank In which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years, <br /> (N Temporary closures x $80) (See above N3 tq. calculate turtharge) <br /> 4 . *Permanent Closure (per tank) Underground Storlage tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank . <br /> ( # - Permanent Closures x $90) <br /> S. 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 worktheet <br /> with your check , <br /> EXAMPLE_ - Annual Fee for Facility with 4 ranks <br /> ( 1 regular, I unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> 1). 3 Additional Tanks x $50 150 <br /> �'. State Surcharge, 4 Tanks x $56 224 <br /> Intal Number of Tanks 4 f Total fee Due $524 <br /> � �.' �.� ' ,�. r •;arm �; ,x ss� <br /> MBoth closures will be conditioned, Contact a Health District Representative. <br /> �hF � ;:��r � .. p+. - „i„ I"71p"•,o'7jV• r:' -_ 'j.A GIVf�rq�Fn%'{ 'yt� a, _ o <br /> -86 <br /> i ".^ r�±j�= r��Fi S ' ,I° •rh �' .. s 14'3p'�' iii � '�,7},�q}u r <br /> V , "'^ ;6 Vii'} _.4. ; YrAP.• ✓ k'�':' ✓�,S ya,Y 'S h. _'f . <br />