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FEE WORKSHEET <br /> DBA srowa Al of G19L'r <br /> ADDRESS c 7a-2 Irl 09Wj wotz`n bg. GC# �S 6 <br /> 1 . New Facility or Addition 6� <br /> ca) First Tank $180. <br /> b. Additional Tanks (# 0 Additional Tanks x $50) D <br /> L 0perating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. S ca <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> J. State Surcharge (per tank) (Due with Permit Application, <br /> on renpwa.l or amendment of operation permit) <br /> (S56 x Total -�f _ Tanks) do <br /> . *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) <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 /> (= Permanent Closures x $90) <br /> Total Number of Tanks � ' Total Fee Due elat 40L�R <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet ' <br /> with vnur 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 /> 2. State Surcharge, 4 Tanks x $56 <br /> Total Number of Tanks 4 Total Fee Due 1WROM ENTAL HEALTH <br /> F ERMiT <br /> ,/ ERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 1-86 0 46 <br />