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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> ADDRESS I905 Is, ��CST�O 1tV <br /> MAILING ADDRESS "� �(2j�{Z S �{Cfz�\ 9.7201 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (1 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 /> (556 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 /3 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 /> (1 ( Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> g01n-,DC-A-L- Fu'&LOlL--T �K <br /> Tc,VKP. CLDSc>> i� P6. <br /> Total Number of Tanks t Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . <br /> PA yhlepqr <br /> RECE VED <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks A U G 8 )9�4 <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ENWRONAIENTAL <br /> Ia. Existing Facility & 1st Tank 5150 PERMIT ERVI ES^LTH <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-a6 <br /> UCS � I <br />