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Nl <br /> FEE WORKSHEET PER EACH FAC1LT <br /> DBA ; -� FACILITY <br /> /Z5 ADDRESS r <br /> MAILING ADDRESS ,t;�t 11 vfkc C [ _ ✓} � qq <br /> New Facility or Addition <br /> a. First Tank $180. '' <br /> b. Additional Tanks (# 2 Additional Tanks x $50) _ <br /> Operating Permit Application/Annual Inspection Fee <br /> , <br /> a. Existing Facility and 1st Tank @ $150. �SD , <br /> a <br /> b. Additional Tanks (# Additional Tanks x $50) d 0 ' <br /> �-- <br /> State Surcharge (per tank) (Due with Permit Application, r <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($lu x Tota 1 # Tanks) <br /> 4 *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to , , �b <br /> re-use tank within 2 years. <br /> kl y, (# Temporary closures x $80) (See above #3 to calculate surcharge) , <br /> 5. *Permanent C1 osure ) g g <br /> (per tank Underground Storage Tank in which <br /> � storage has ceased and where the owner/operator has no intent <br /> � of re-using tank within next 2 years. <br /> (# Permanent Closures x $90) <br /> asm <br /> y 3 , <br /> s � rV <br /> x <br /> Total Number of Tanks " ` Total Fee Due <br /> k <br /> Make all fees payable to San Joaquin Local Health District.? Enclose this worksheet <br /> 0 - w <br /> with your check. f _ <br /> � _ .- EXAMPLE - Annual Fee for Faci 1 i ty with 4 Tanks 4 <br /> (1 regular, 1 unleaded 1 supreme 1 waste oil ) � �•:. <br /> la. ,-Existing Facility & 1st Tank , r �- � $150 <br /> b. '3 Additional Tanks x $50 '° a 150 <br />" } 2. State Surcharge, 4 Tanks x $56224x <br /> t b .3' ' t h <br /> Y" R + <br /> h ? <br /> Total Number of Tanks 4 ��� ` Total Fee Due $524 P <br /> _ <br /> RV3 k <br /> *both closures will be conditioned. Contact a Health District Representative. <br /> O �fi e <br /> 2 86 �`trlr 4 <br /> " ;l.k ��-€m...a«..r. .A ,. ,.r- x a• ;t # ...- .. <br />