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FEF WORKSHEET PER EACH FACIL i' <br /> I Erzq 1 fir. ! <br /> FACILITY � <br /> DBA _�'�ryi o,4' ro��T©.�l ADDRESS 41010 G /1/,1Al'.4 z '— <br /> BAILING ADDRESS_,-r-y� _f-1 441-. <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. Jed <br /> b. Additional Tanks (# / Additional Tanks x $50) -50 <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # Z Tanks) 112- <br /> 4- <br /> /24_ *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 /> (# Temporary closures x $80) (See above #3 to calculate surcharge) <br /> 5. *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 within next 2 years. <br /> (� Permanent Closures x $90) <br /> Total Number of Tanks 2 Total Fee Due X12 <br /> all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> iii your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> 1a. Existing Facility & Ist Tank Czaly <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 224MAR 2 6 1986 <br /> Total Number of Tanks 4 Total Fee Due 4PJpif20M ENTAL HEALTH <br /> F€W011'/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />