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FEE WOkk-SliEET PER EACH FACILITY* � � � r <br /> FACILITY �(;� ,, , <br /> DBA f ��( �1} LaoaREss =1 r j , <br /> MAILING ADDRESS <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 #3 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 /> (0 Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total <br /> Fee Due <br /> * Make all fees payable to San Joaquin Local Health District. Enclo a this worksheet <br /> with your check. �-�� <br /> YMEHT <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> REGEIVE,D <br /> ( 1 regular, 1 unleaded, 1 supreme, i waste oil ) (=E='6 25 1'9'9-R <br /> la. Existing Facility R 1st Tank $150 <br /> 150 \/iRONMENTAL HEALTH <br /> b. 3 Additional Tanks x $50 PERMIT/SERVICES <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 /> z-„r <br />