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FEE WORKSHL£.T PER EACH FACILITY a]�T Pf <br /> '%' FACT L I TY _ "we <br /> DBA rc � ADDRESS �7 r r 0 6 <br /> MAILING ADDRESS o . ' 6e fl <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (I 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 /> (I 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 . PAYMENT � -�� <br /> (I _ Permanent Closures x $90) RECEIVED U' l� <br /> Plan Check Fee $30. NOV 4 1988 <br /> EWRONMENT'AL HEALTH <br /> PERMIT/SERVECES c� -7 <br /> tal Humber of Tanks --3 Total Fee Due <br /> 'ees payable to San Joaquin Local Health District. Encloset�this worksheet <br /> check . cl'3 3 3 <br /> y 71:1 <br /> -'LE - Annual 'Fee for Facility with 4 Tanks <br /> ( 1 regular, I unleaded, 1 supreme. 1 waste oil ) <br /> Ia. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total 'Fee Due $524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-1116 <br /> u a-T_ '2 1 <br />