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fEE WORKSHEET PER EACH fACI 11Y.. <br />MAILING ADDRESS /01 <br />FWD <br />1. Operating Penni t Appl #+AtiOn/llMwltlitQi►tza �. <br />�z r <br />i �' us *F .iJ;v . S'F S•• , <br />a. First Tank at Facility P� e k W< <br />Tairks <br />b. Additional Tanks (NT ldd#tlogal ` <br />2. State Surcharge (per tank) (Due with Per�oait `Appltio; <br />on renewal or amendment of operation permit and.teiporary closure) <br />($56 x Total N Tanks) —' <br />3. *Temporary Closure (per tank) Underground StorageTank:in which <br />ssto <br />storage has ceased but where the-ownerloperator prop0 e <br />re -use tank within 2 years. <br />(/ <br />Temporaryr closures x $80)^ (See above h3 to calculate surcharge) <br />4. *Permanent Closure (per tank) Underground Storage Tank I in which <br />storage has ceased and where the owner/operator has no intent <br />of re -using tank`. <br />(0 Permanent Closures x $90) <br />5. Pian Check Fee $30. <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 />C(DPI <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular. 1 unleaded, I supreme. 1 waste oil) <br />Ia. Existing Facility 6 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x S56 <br />Total Number of Tanks 4 <br />Total Fee Due <br />$150 <br />150 <br />224 <br />$524 <br />`Both closures will be conditioned. Contact a Health District Representative. <br />2-86 <br />T <br />