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FEE WOf T PER EACH FACILITY <br /> ' (7 FACILITY <br /> DDA , ADDRESS 1-4 <br /> , <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. �J�Q <br /> b. Additional Tanks (M 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 # .3 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 /> (1 Temporary closures x $80) (See above N3 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 /> (1' Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> COPY <br /> Total Number of Tanks .3 Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. PAYMENT <br /> RECEIVED <br /> NOV 17 1988 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> i*NY- NMENTAL HEALTH <br /> % <br /> (1 regular. 1 unleaded 1 supreme. 1 waste o� ERMITISERVICES <br /> Ia. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge. 4 Tanks x 556 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Doth closures will be conditioned. Contact a Health District Representative. <br /> EH 23 032 2/86 <br />