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F(E WORKSHEET PER EACH FACILITY" — <br /> /� FACILITY /L <br /> DBA ADDRESS , 1 ?�1P.�aIZ ��� S Tait/, C <br /> MAILING ADDRESS 7 • W, 0 S'ZOl <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ 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 /> (S66 x Total N Tanks) <br /> 3. 'Temporary Closure (per tank) Underground Storage Tank to which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (1_ Temporary closures x $80) (See above 03 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 /> S. Plan Check Fee $30. <br /> n <br /> Total Number of Tanks Total Fee Due <br /> Hake all fees payable to San Joaquin Local Health District. Enclose this worksheet U\Z—Y-1' <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 6 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 S524 <br /> Both closures will be conditioned. Contact a Health District Representative. <br />