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EE uORKSHLET PER EACIi FACILITY <br /> FACILITY <br /> DBA y`k'rk t,,U &CMsr/hJrrleV ADDRESS 4Y'i3- <br /> F /??gF"ucvT si 5%ori ? i <br /> A/o/,'rl4 C4< C e v 17A'✓r tiCN <br /> MAILING ADDRESS_] izl - ,Lj4,5;,cViiet.>utr cfi Pb is 1,y _.4-9 !ir0C*7-cw e <br /> 1. Operating Permit Application/Annual Inspection Fee <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 /> ($56 x Total M 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 N3 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 /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee�....u//e <br /> Make all fees payable to San Joaquin Local Health District. Enclose worksheet <br /> with your check . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, l supreme, 1 waste oil ) <br /> Ia. Existing Facility 6 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 District Representative. <br /> ii,, 7 <br />