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I <br />1 <br />1 <br />FEE WO/RRKSHEET �PER EACH FACILITY06 <br />FACILITY <L <br />ADDRESS ��L71 l� G1J�l .. &0dCfr— <br />MAILING ADDRESS <br />v <br />I. <br />J. <br />Operating Permit Application/Annual <br />Inspection Fee <br />a. First Tank at Facility @ <br />$150. <br />b. Additional Tanks (N <br />Additional Tanks x $50) <br />2• <br />State Surcharge (per tank) (Due <br />with Permit Application. <br />on renewal or amendment of operation permit andtemporary closure) <br />($56 x Total N Tanks) <br />3. <br />`Temporary Closure (per tank) <br />Underground Storage Tank in which <br />storage has ceased but where <br />the owner/operator proposes to <br />re -use tank within 2 years. <br />(#_ Temporary closures x <br />$80) (See above /3 to calculate surcharge) <br />4- <br />'Permanent Closure (per tank) <br />Underground Storage Tank in which <br />storage has ceased and where <br />the 9wner/operator has no intent <br />of re -using tank, <br />0 / Permanent Closures x <br />$90) PAYMENT <br />RECEIVE( <br />S. <br />Plan Check Fee $30. <br />DEC 7 <br />-W RON A,0'J'1 A', HLkAI rN <br />Total Number of Tanks � <br />SSFF %,. <br />PERMq�L3Riv%� Due 9d <br />Make all fees payable to San Joaquin Local Health District. <br />with your check. <br />Enclose this worksheet <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, 1 waste oil) <br />la. Existing Facility 8 1st Tank 5150 <br />b. 3 Additional Tanks x $50 150 <br />2. State Surcharge, 4 Tanks x $56 224 <br />'Both cl <br />2-N6 <br />Total Number of Tanks 4 Total Fee Due $524 <br />s will be conditioned. Contact a Health District Representative. <br />