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fCE WORKSIICET PER EACH <br /> HF�FACILI1Y <br /> DBA 121FilZlCl��l `)i4l�i�/ /' ADDRESS <br /> MAILING ADDRESS Gj/¢�((�_ <br /> I. Operating Permit <br /> Applicetton/Annual inspection Fee S <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/_L 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 A ! Tanks) <br /> 3• <br /> *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 /> 0 Temporary closures x $80) (See above 03 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 /> 0 ( Permanent Closures x $90) l� <br /> 5. Plan Check Fee $30, <br /> Total Number of Tanks j 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, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility b 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 /> •Goth closures will be conditioned Contact a lleal [h District Representative. <br /> 2-it4 <br />