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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> (iaA ltSBy . ��is�u�� ADDRESS X). Al' ��G�2o�_Qca.�_ f �T/'�✓ <br /> MAILING ADDRESS S14 <br /> 1. Operating Permit Application/Annual Inspection Fee MCI ibo ADL b 7O r'z <br /> a. First Tank at Facility @ $150. S_G — <br /> b. Additional Tanks (I Additional Tanks x $50) Z Ob <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> t <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total N 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 /> (#_ Temporary closures x $80) (See above 03 to, calculate surcharge) <br /> 4. "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the 9wner/operator has no intent <br /> of re-using tank , <br /> PAYMENT <br /> (I_ Permanent Closures x $90) RECEIVED <br /> 5. Plan Check Fee $30. SEP 2 1988 <br /> FNVIRROMSE <br /> MIALHEALTH ��J� <br /> Total Number of Tanks PER %jjj Fee Due J <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, 1 waste oil ) <br /> Ia. Existing Facility b 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 /> *Both closures will be conditioned. Contact a Health Oistrict Representative. <br /> 2-!),6 <br /> UGC al <br />