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tLE WORKSHEET PER EACH FACILITY <br /> FACILITY r <br /> DBA �C �Ty FINN A�va ADDRESS pD�D �Yllg/" <br /> MAILING ADDRESS �J0if-ro C ✓1 ScS7� <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (#, r 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 /> (S56 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 /> �porary 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 , <br /> (N� Permanent Closures x $90) 90 <br /> S. Plan Check Fee $30. <br /> /SG �10 Z <br /> Total Number of Tanks Total fee Due 55Y2 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> .p AY�ENT <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ft E CEiV ED <br /> ( I regular, I unleaded, 1 supreme, I waste oil ) 3014 8 I98a <br /> Ia. Existing Facility & 1st Tank $150 <br /> V1RpNMENTM <br /> TAL HEA� <br /> b. 3 Additional Tanks x $50 150 WMITISEvICES <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-rtG <br />