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FEE WORKSHEET PER EACH FACILITY'S ""O <br /> FACILITY En9'ne G'" 3 <br /> DBA ADDRESS ///G E j;=j¢sT ST <br /> MAILING ADDRESS Cj7-V }-4 44,,. 2mm 5112 SToc/� re�/, e-4 9 .5 <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. X50 <br /> b. Additional Tanks (# / Additional Tanks x $50) .50 <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # Z Tanks) /�2 <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 2 Total Fee Due 3/2 <br /> M= ke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> -Jth your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank D1 �T air�a <br /> b. 3 Additional Tanks x $50 J� <br /> 2. State Surcharge, 4 Tanks x $56 —�IlAR 28 1985 <br /> Total Number of Tanks 4 Total Fee Due E7W kMENTAL HEALTH <br /> FERMIT/SERVICES <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 2-86 `, <br />