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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY I/ <br /> ; <br /> may; <br /> DBA._ C ADDRESS <br /> MAILING ADDRESS �� �' �� �D <br /> 1. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 /> (1' Temporary closures x $80) (See above 13 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 /> (# Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> n? <br /> Total Number of Tanks ! Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose Y M E this worksheet <br /> with your check . RECEIVED <br /> AUG 1 G 1988 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ENVIRONMENTAL HEALTH <br /> — <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) PERMITJSERVICES <br /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> PAYMENT <br /> Total Fee Due $524 <br /> Total Number of Tanks 4 RECEIVED <br /> AUG 16 1988 <br /> 'Both closures will be conditioned. Contact a Health District RepreiWR049NTAL HEALTH <br /> PERMITISERVICES <br /> 2 „G <br /> 0 C--7 � 1 <br />