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FEE wORKSHLET. PER EACH FACILII1.,,. <br /> FACILITY * - a T <br /> DBA ` � i (_- t_ - ADDRESS ) � '/I,,/ J) e. <br /> MAILING ADDRESS I � .'�G }j G -'le' ;. .1, .5 3 . ) <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. S�oJ <br /> b. Additional Tanks (H / Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> gb <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total BZ, Tanks) �� L <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 /> �i i� 00 <br /> (N % Permanent Closures x $90) a 7 ��4 JPO <br /> 5. Plan Check Fee $30. <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 /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) . <br /> la. 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 /> 90T at y- <br />