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FEE WORKSHEET PER EACH FACILITY� <br />FACILITY <br />DBA ADDRESS <br />MAILING ADDRESS ti1 t G 1,:.�a�P diZ.. °4.�,•y "t. <br />" 1. New Facility or Addition <br />a. First Tank $180. <br />b.:, Additional Tanks (# Additional Tanks x $50) <br />2. Operating Permit Application/Annual Inspection Fee.' <br />a;; Existing Facility and 1st Tank @ $150'9' <br />b. Additional Tanks (# Additional Tanks x $501 <br />3. State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit <br />P P and temporary closure), <br />($56 x Total # 1 Tanks) ,o • �Q <br />4. *Temporary Closure (per tank) Underground Storage Tank -inwhich <br />storage has ceased but where the owner/operator proposes to `5 <br />F <br />._ /Im-use tank within 2 years." <br />(# Temporary closures x $80) (See above #3 to calculate surcharge) <br />5. *Permanent Closure (per tank) Underground Storage Tank in which <br />storage has ceased and where the owner/operator has no intent J s` <br />d <br />of re -using tank within next 2 years. j <br />>r (# Permanent Closures x $90) <br />�r <br />Total NOmber of Tanks [ Total Fee Due car) <br />Make all feesa able to San Joaquin Local Health District. Enclose this worksheet xr <br />P Y 9 <br />with your check. +;' <br />e' r <br />xll <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, 1 waste oil) r,$ <br />la. Existing Facility & 1st Tank $150 <br />b. 3 Additional Tanks x $50 150 <br />2. State Surcharge, 4 Tanks x $56 224 D �y <br />Total Number of Tanks 4 Total Fee Due $524 MARIis <br />00, <br />g _ EAIViRf r .. 1 -AL HEAL <br />EALTH <br />FERI11 AERVICE <br />*Both closures will be conditioned. Contact a Health District Representative, <br />2-86 <br />F1 � <br />y r <br />4. h <br />