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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DBA. E�T/17�� ADDRESS <br /> MAILING ADDRESS zd�tis �p(A/ �i fj(-t — ;�p , l�����t{ 3�_ �eJ///�R _�� <br /> 1. Operating Permit Application/Annual Inspection Fee q p 7 <br /> ,a. First Tank at Facility @ $150. ���/©U / to U o U <br /> b. Additional Tanks (l—L Additional Tanks x $50) ,5/4 - <br /> 2. . State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure)l <br /> ($56 x Total M / Tanks) _ 0 (o9a) <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. IV <br /> ) I�LII;f� sf,- Tirne��n <br /> (/_ Temporary closures x $80) (See above /3 to calculate sure <br /> 4• *Permanent Closure (per tank) Underground Storage Tank in which JUN 10 1988 <br /> storage has ceased and where the owner/operator has no intent <br /> ENVIROMENTAL HEALTH <br /> of re-using tank . FERMIT/SERVIC <br /> 0 Permanent Closures x $90) O <br /> 5. Plan Check Fee $30. <br /> Om <br /> Total Number of Tanks Total Fee Due 41� <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, I unleaded, I 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 S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> • <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-7;G <br /> _ v <br />