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FEE WGRKSHLET PER EACH FACILITY" <br /> FACILITY <br /> DBA I (C G ADDRESS w4`7 ! 57l <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First-Tank-at facility @-$-150. - <br /> b. Additional Tanks (q / _ Additional Tanks x $50) 15-0 <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 q—L 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. IZZ <br /> (#_ Temporary closures x $80) (See above q3 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 /> B <br /> (q Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> �7J 67� <br /> Total Number of Tanks ( Total Fee Due 1� <br /> Ca ra, c 6,u i�M(r?ji 7 n� v� 00 <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, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 <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 /> *doth closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> r <br />