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FCE .WORKSH'LET PER EACH MILO$ fACILITY pjkk1( <br /> ADDRESS d$ <br /> DBAISo ( v_ <br /> MAILING ADDRESS C.0 <br /> Application/Annual inspection Fee <br /> 1, Operating Fermat AQP / <br /> a, First Tank at Facilitmp Additjonal Tanks x $50) <br /> b. Additional Tanks (��Due with Permit Application, <br /> r tank) ( closure) <br /> 2. State Surcharge (per permit and temporary <br /> on renewal or amendment of Operation pe <br /> ($56 x Total # -z— a Tank in which <br /> 3. *Temporary Closure (per tank) Underground Storage <br /> storage e has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. �— <br /> ar closures x $84) (See above #3 to calculate surcharge) <br /> (#. Temporary e Tank in whit <br /> (per tank) Underground Storage R E c E l V E D <br /> 4. *permanent Closure (P rator has no intent <br /> storage has ceased 'and where the QwnerloPe SEP 1 � ���� 9C) <br /> of re-using tank. ENVIRONMENTAL HEALTFt" <br /> (#__L_ Permanent Closures x $94) PERM1TJSERVICES _ <br /> 5, Plan Check Fee $30. <br /> 5- <br /> Total Fee Due <br /> Total Number of Tanks <br /> San .loa uin Local Health District. Enclose this worksheet <br /> Make all fees payable to <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme. I waste oil ) <br /> $154 <br /> la. Existing Facility b 1st Tank <br /> 150 <br /> b. 3 Additional Tanks x $50 224 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> Total Dumber of Tanks 4 <br /> Total Fee flue $524 <br /> *Both closures well be conditioned. Contact a Health District Re resentative. <br />