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FEE WORKSHLET PER EACH FACiLOW <br /> l FACILITY <br /> DBA ti ADDRESS <br /> MAILING ADDRESS S1dQ <br /> 3 �o r4,L 6 = /off <br /> 1 . Operating Permit Application/Annual Inspection Fee ? �D <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 # 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 /> (N Temporary closures x $80) (See above M3 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 /> (N---� Permanent Closures x $90) 00 <br /> 5. Plan Check Fee $30. / (J <br /> a <br /> o / <br /> Total Number of Tanks 1 Total Fee Due Z�_ GLS <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, l supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> h. 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-..6 <br />