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FEE WORKSHLET PER EACH FACILITY �^� <br /> FACILITY -769 <br /> /�CLCC/ <br /> DBA h ,`S ADDRESS ��I v/f' <br /> MAILING ADDRESS 7 D O- � � �` ' <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 I Tanks) PAYMENT <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which R E C EI V E D <br /> storage has ceased but where the owner/operator proposes to SEP 2 j 1984 <br /> re-use tank within 2 years. fNVIR <br /> }{} — <br /> �QNMENTgL HFq <br /> (I— Temporary closures x $80) (See above 03 to. calculate surcha MIT/SERVICES <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 g� <br /> (I/ Permanent Closures x $90) �J� <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, /w�orrksheet cA <br /> with your check, * 101&3 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme. 1 waste oil ) <br /> Ia. Existing Facility 8 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 /> *Roth closures will be conditioned. Contact a Health District Representative. <br /> EH 23 032 2/86 <br />