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.WORKSHEET PER EACH FACILIT# <br /> FACILITY <br /> BA - �1_' Tl: nX Tar ADDRESS 17 r,9 _rJT PT A B O AVE- _ <br /> MAILING ADDRESS 3TOCKTOK9 CALTF. q9203 <br /> 1. -Wew--Eacility or Addition <br /> a. F i rs t-'anik, -$j80. <br /> b. Additional Tanks ----Additional--Tanker-a-W) - <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150, / <br /> b, Additional Tanks (# `: Additional Tanks x $50) /. ► <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or am ndment of operation permit and temporary closure) <br /> o f jc- <br /> ($56 x Total # Tanks) <br /> 4. *Temporary Close (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 /> (# Temporary closures x $80) (See above #3 to calculate surcharge) <br /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> r (� <br /> Total Number of Tanks Total Fee Duel <br /> t� <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 /> la. '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 /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />