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FEE WORKSHEET PER EACH FACILIT` <br /> FACILITY <br /> DBA -� <br /> Tdpl�l 9ARR1E p( punnrlrmc compm ADDRESS 10144E French Camp Road <br /> MAILING ADDRESS,, 1k1m g,x 1n144 Manrprn C.A Q5336 <br /> PCO# 12907 J. S. KISHTYAMA (This facility is "Ag Exempt". Primarily an agricultural <br /> operation) <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. 0 <br /> b. Additional Tanks (# Additional Tanks x $50) n <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 # Tanks) 0- <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 #3 to calculate surcharge) 0 <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) 0 <br /> 5. <br /> Total Number of Tanks Total Fee Due 0 <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 & 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 /> 2-86 <br /> e <br />