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tLL WORKSHLLT PER EACH FACILITY _ <br /> � � FACILITY <br /> DBAC, <br /> �iC' � jh�n�Jj�'/C�ltri.� ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilit.Y @ $150. <br /> b. Additional Tanks (/ 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 /> 056 x Total 1 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 /> a <br /> (1_ Temporary closures x $80) (See above /3 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 /> 0 Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> i Total Number of Tanks 0? 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 /> ( I regular, 1 unleaded. 1 supreme, 1 waste oil ) / <br /> Ia. Existing Facility 6 1st Tank $150 3 <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 /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-a6 <br /> U6�- al <br />