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FEE-WORK-SHLET PER EACH FACILITY <br /> �,�—(� L FACILITYSZ�N� cr r�J <br /> DBAdcl I`� �If12F3 ADDRESS b 23 S �zesN , <br /> MAILING ADDRESS S 3 $ <J kALa <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (A 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 /> (S56 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 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. / k <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 /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> 0 regular, l unleaded, 1 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 PAYMENT <br /> RECEIVED <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> r 1U <br /> ENVIRONMENT41 HEAL;TFI <br /> *60th closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> 1)0,-r <br />