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ttt WORKSHLET PER EACH FACIL O • <br /> DBA Pg�m Q FACILITY <br /> 05, 1j0 C. ADDRESS 113 N Walotvt /moiDorf <br /> MA1L[NG ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 M 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 /> O (B_ Temporary closures x $80) (See above N3 to calculate surcharge) <br /> *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where they owner/operator has no intent <br /> of re-using tank , I <br /> (N_o2 Permanent Closures x $90) itECE VED <br /> � 180�- <br /> 5. Plan Check Fee $30. FEB 21988 <br /> JMP,0 MENTAL HEALTH <br /> VERMITjS€RjlCE$ <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, l unleaded, 1 supreme, 1 waste oil ) <br /> Ia. 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 <br /> ur'T 'a 1 0 <br />