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FEE WORKSHE_LT PER EACH FAC1L11 . ft <br /> FACILITY <br /> DBA fir' L,Q(,.k)R Y ^ ADDRESS <br /> MAILING ADDRESS ( Z(_D 1,J —1 u NC D L-012t , CP � T <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (# 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 . PAYMENT <br /> (# 2 REG�IVED Permanent Closures x $90) 4 l `aC� 00 <br /> 5. Plan Check Fee $30. FEB 51987 <br /> ENVIRONMENTAL HEALTH <br /> pERMITISERVICES <br /> Total Number of Tanks 2 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, I supreme, 1 waste oil ) <br /> la. 'Existing Facility & lst 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 /> *Doth closures will be conditioned. Contact a Health District Representative_ <br /> 2-86 <br /> 0(9-T- a I <br />