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FEE WORKSHEET PER EACH F Y <br />OBA (�t•�p- (0;t St-�4�o.. FACILITY <br />ADDRESS 1n.4 9 6�-° <br />MAILING ADDRESS 5 rE <br />PAI 04x4, <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (# 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 <br />re -use tank within 2 years. <br />(# Temporary closures x $80) (See above #3 to calculate surcharge) <br />4. *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. <br />(# Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks Total Fee Due 30.0 <br />0 <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, <br />la. Existing Facility & 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />1 waste NY F- I <br />$150 <br />NV'IR N ENT ` - KC <br />IRA <br />EE R M . Tf� -j <br />Total Fee Due $524 <br />*Both closures will be conditioned. Contact a Health District Representative. <br />2-86 <br />