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RE uORKSHLET PER EACH FACIL,%., �v -- „,�., <br /> fACILITY � <br /> DBA ADDRESS �SL ti+ t L<M �rto <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee J _ <br /> a. First Tank at facility @ $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 /> 456 x Total A 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 13 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 /> (/_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <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 /> PAYMENT <br /> RECElV ED <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks U E C q ' 1GA7 <br /> ( 1 regular. 1 unleaded, l supreme. 1 waste oil ) INWRONMENTAL HEALTH <br /> Ia. Existing Facility b 1st Tank $150 PERMIT/SERVICES <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 District Representative. <br /> 2 -m <br />