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&'12 2 <br /> FEE WORKSHLET PER EACH FACiLI <br /> 4 <br /> DBA N & S Irrigation FACILITY 215 W. Main, Ripon <br /> ADDRESS <br /> MAILING ADDRESS 215 W. Main, Ripon <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 N Tanks) <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owmer/operator proposes to <br /> re-use tank within 2 years. <br /> (# Temporary closures x $80) (See above N3 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 . DATE PAID <br /> (# 2 Permanent Closures x $90) $180 <br /> CK. NO. <br /> 5. Plan Check Fee $30. <br /> AMT. PD. <br /> DISCOUNT <br /> Total Number of Tanks 2 Total Fee Due $180 <br /> Billing date: 4/22/87 - Due IMMEDIATELY <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> DATE PAID ��q- T <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks CK. NO. <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) AMT. PD. d, ao <br /> Ia. Existing Facility & 1st Tank $150 <br /> UlsCot;r,4T <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 /> -86 <br /> -T- <br /> a 1 <br />