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CE WORKSHEET PER EACH ACILIIY • S <br /> s 3y's " Y <br /> V? ADDRESSfl .k is TG4 <br /> BA ._j 3 E ; <br /> � Te Yet <br /> AILING ADDRESS r S <br /> 1, Operating Permit Application/Annual Inspection Fee 5 0 <br /> 1 So <br /> a, First Tank at facility @ Additional Tanks x $50) <br /> b, Additional Tanks (N _ <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 NIA Tanks) <br /> 3. "Temporary Closure (per tank) Underground Storage Tank in which <br /> rator proposes to <br /> storage has ceased but where the owner/ope <br /> re-use tank within 2 years. <br /> (N_ Temporary closures x $80) (See above Stor geo7ankcinate whichreharge) <br /> 4, "Permanent Closure (per tank) <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 /> �, s1 <br /> Total Number of Tanks Total Fee Due <br /> Local Health District. Enclose this worksheet3 <br /> Make all fees payable to San Joaquin <br /> cy""`� <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks l waste oil) ✓ <br /> (l regular, l unleaded, 1 supreme, $150 <br /> Ia. Existing Facility 6 1st Tank 150 <br /> b. 3 Additional Tanks x $50 224 <br /> 2. State Surcharge, 4 Tanks x 556 _ <br /> Total Number of Tanks 4 <br /> Total Fee Due $524 <br /> act a Health District Representative_ <br /> -Both closures will be conditioned. Cont <br /> 7 -P,G <br />