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FEE WORKSHEET PER EACH FACILIIv-- <br /> de FACILITY <br /> DBA �r�rTyl( /IU4Cl+Iult77� t c c/ ci^ r ADDRESS <br /> MAILING ADDRESS F79 t �K 45ilZ1Jr 95ZD� <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) -' <br /> 2. Operating Permit Application/Annual Inspection Fee - --- <br /> a. Existing Facility and 1st Tank @ $150. l�'D <br /> b. Additional Tanks Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit' and temporary closure) alp <br /> ($56 x Total # / Tanks) <br /> 4. *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 /> (#_ Temporary closures x $80) (See above #3 to calculate surcharge) <br /> 5. *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 within next 2 years. <br /> (#_ Permanent Closures x $90) <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 /> i <br /> EXAMPLE. - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil) { <br /> 1 <br /> la. Existing Facility 3 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 /> — a <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />