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FEE WORKSHEET PER EACH FACILITYb 118 <br /> l FACILITY y ry c,� �V� , <aC/ L ej <br /> DBA �O r� 11� f� �� ADDRESS I ,C <br /> MAILING ADDRESS <br /> 1� '�bp"eratingtPermWApplication/Mnual,: Inspection Fee <br /> a. First Tank at Facility @-$150. <br /> b: Additional Tanks (f 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 M 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 f3 to, calculate surcharge) i: <br /> 4. "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased ind where the owner/operator has no int7nt <br /> of re-using tank, w T� <br /> (/ I Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> q�, ov <br /> Total Number of Tanks Total Fee Due L— <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> M� <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks �� <br /> ( 1 regular, l unleaded , 1 supreme, 1 waste oil ) <br /> Ia . Existing Facility 8 1st Tank 5150 <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 /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-rib • • <br /> UG7 � f <br />