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FEE PORKSHEET PER EACH FACIL4 <br /> DBA, cG� , FACILITY <br /> Lt. _c. ADDRESS 2i(o (,rJ < c <br /> MAILING ADDRESS (D- f p tAj.Ad L <br /> I• Operating Permit Application/Annum Inspection Fee <br /> a. First Tank at Facility @ $I50. <br /> b. Additional Tanks (# Additional Tanks x $5O) <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 # 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 #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 . ! <br /> S c- <br /> (#—_�_ Permanent Closures x Ego) q6 <br /> 5. Plan Check Fee $30. / /�,� . �� o° <br /> Ck /gib <br /> Total Number of Tanks <br /> Total Fee Due 76°© <br /> Make all fees payable to San Joa uin Local Health District. Enclose this worksheet <br /> with your check <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, I unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility b 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 /> r <br /> 0(3-7- 1� <br />