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fEE WORK•SHLET PER EACH FACILITY <br /> FACILITY <br /> OdA C � ' ,q<riCS�� NjCC ADDRESS >t2cM010--i <br /> MAILING ADDRESS e(j ?�� ,C <br /> 1. Operating Permit Application/Annual Inspection Fee o J <br /> a. First Tank at Facility @ 5150. 15� <br /> b. Additional Tanks (I 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 /> (S56 x Total NTanks) Jr�O <br /> 3. 'Te-rnporary 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 /> (#_ Temporary closures x $80) (See above /3 to calculate surcharge) <br /> 4• `Permanent Closure (per tank) Underground Storage Taah4 in which <br /> ( storage has ceased and where the owner/operator ha�sFtrey' A nt <br /> of re-using tank , F�`� <br /> (9 Permanent Closures x $90) ZOO <br /> 5. Plan Check Fee 530. pF �%�Tg2y <br /> /CFS��Th <br /> Total Number of Tanks Total Fee 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, I waste oil ) <br /> Ia. Existing Facility b 1st Tank 5150 <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 /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> Z-riL <br />