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FEE WORKISHEET PER EACH FACILO <br /> FACILITY J?aL <br /> 1�EE1�T <br /> DBA 5 nc 1c ADDRESS ;?Z sem' <br /> MAILING ADDRESS _rJ4Ge ern BIZ <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. <br /> b. Additional Tanks (# 2 Additional Tanks x $50) f �� <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 #3_ Tanks) <br /> 4. *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 Total Fee Due ¢18 <br /> 1 <br /> V.:-ke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> ;iin your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> '(1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la, Existing Facility & 1st Tank V u <br /> b. 3 Additional Tanks x $50 v 5 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> ^� aM AL HEALTH <br /> F-WR <br /> Total Number of Tanks 4 Total 'Fee Due F6524T/SERVICES <br /> *Both closures will be conditioned. Contact a Health District. Representative. <br /> 2-86 <br />