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E RKSHIET PER EACH FACILITY <br /> EE 0 FACILITY � <br /> DBA / C// � ADDRESS Z 822 <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee � LS <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (0—L 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 # Tanks) <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to PAYMENT <br /> re-use tank within 2 years. RECEIVED <br /> (I Temporary closures x $80) (See above 03 to calculate surcharge) <br /> JAN <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and; where the owner/operator has no intent ENVIRONMENTAL HEALTH <br /> PERM!TISERVICES <br /> of re-using tank . <br /> (# Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> pG <br /> Total Number of Tanks <br /> Total fee Due Ll 61, <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 /> ( I regular, I unleaded , 1 supreme, I waste oil ) <br /> la. Existing Facility & Ist 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 -„r, <br /> 00-7- a r' <br />