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rLL WURKSHLLT PER EACH FACILIT <br />FACILITY <br />OBA Cis ADDRESS rt <br />v <br />MAIL ING ADDRESS <br />/77a e., %i --- /t/C) (' <br />1. Operating Permit Applicatiun/Annual Inspection Fee <br />a. First Tank at Facilitv @ $150. (�Ic <br />b. Additional Tanks (N 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 # t Tanks') 15®� <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 />(N Temporary closures x $80) (See above d3 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 />(N t Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks <br />A VA <br />PTIME-Mm <br />VI <br />PE IT <br />ota ee Due <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, 1 unleaded, 1 supreme, 1 waste oil) <br />Ia. Existing Facility & 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 />*Both closures will be conditioned. Contact a Health District Representative. <br />2-86 <br />aTr a 1 <br />