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FEE W.ORKSHLET PER EACH FACILI • <br /> FACILITY / / Z~ <br /> UBA ~ Uo S o �a 3 I C 2 ADDRESS Z4/� G��or tip bx5 <br /> MAILING ADDRESS /W t'e—'L% J <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (#0 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 Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (N70� Temporary closures x $80) (See above H3 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 . Q /� <br /> (N ( Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due Q 0 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . REGE VgTD <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks 3u <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) u4w'ONMENTRVICES`TH <br /> Ia. Existing Facility & 1st Tank $150 <br /> PERMIT ISE <br /> h. 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 />