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FEE WORKSHEET PER EACH FACILI' <br />} <br />FACILITY <br />At3A�. 'G, 6-� ADDRESS 345 Ne0� �a <br />u®�,,� <br />MAILING ADDRESS 1--C3Mc 31? 14 Ac 6vv, L-ktr> *L -L S^CT43 <br />h <br />I. Operating Permit Application/Annual inspection Fee <br />d. First Tank at Facility 0 $150. <br />b. Additional Tanks (N Additional Tanks x $50) <br />2. State Surcharge (per tank) (Due with Permit Application. <br />w <br />. an renewal or amendment of operation permit and temporary closure) <br />($56 x Total Tanks) <br />'� <br />„99� <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 />(M Temporary closures x $80) (See above N3 tq. 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 />0 9% Permanent Closures x $90) <br />o ' <br />5. Plan Check Fee $30. <br />Total Number of Tanks vZ- Total Fee Due <br />1 �'o 0" <br />r. <br />` <br />x <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 />0 regular, I unleaded, 1 supreme* 1 waste oil, <br />Ia. Existing <br />a{. <br />`# <br />Facility b 1st 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 />I <br />"Roth closures will be conditioned. Contact a Health District Representative. <br />