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FEE WORKSIICET PER EACII FACILITY <br /> FACILITY <br /> 06A ADDRESS /0C 3 Ale FS 3el <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (I 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) U <br /> (S56 x Total K Tanks) <br /> 3. *Temporary Closure (per tank) underground Storage Tank in which <br /> storage has ceased but where the owner/operator p Vkoses to <br /> re-use tank within 2 years. <br /> (I Temporary closures x $80) (See above I3 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 /> (I Permanent Closures x $90) <br /> 5. Plan Check Fee $30. 1 <br /> E1V RUViEN-IAI_ HEALTH <br /> Total Dumber of Tanks <br /> FERMIT/f-otal' Fee Die ,00 <br /> Make all fees payable to San Joa uin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks , P � l <br /> (1 regular, 1 unleaded, 1 supreme. 1 waste oily -' ', <br /> la. Existing Facility & 1st Tank $150 ,/ ✓ <br /> b. 3 Additional Tanks x $SO 150 jr <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 Representatives �' ' <br />