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25 <br /> WORK-,SHEET.0 <br /> �. fACtLtTY <br /> OBA GIN ADDRESS 2 zS <br /> KAILING ADDRESS S <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a first Tank:At :Fac_iIity @ 'S150..;_ c1 <br /> b. Additional Tanks (I—I— Additional Tanks x $50) <br /> 2. -S tate Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total M 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. PAYMENTRECEIVED <br /> (/ Temporary closures x $80) (See above f3 to calculate surcharge) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in whicha N <br /> storage has ceased and, where the owner/operator has no intent INVIRONMENTAL HEALTH <br /> of re-using tank , PERMITISERVICES � <br /> (I Permanent Closures x $90) c � � � ' --�J <br /> 5. Plan Check Fee $30. <br /> G <br /> Total Number of Tanks Total Fee Due <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, I unleaded, 1 supreme, l waste oil ) <br /> Ia. g y n Exi tiFacility 5 1st Tank $150 <br /> Existing <br /> b. 3 Additional Tanks x $50 150 <br /> 2• State Surcharge, 4 Tanks x $S6 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 'Both closures will be conditioned. Contact a Health District Re resentative. <br /> 16 <br />