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FEE WORKSiiCET PER EACH FACILITY <br /> f AC 1 L I TYZr`rw , B <br /> DBA �S��S� e ADORES--,— S-r <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. - <br /> b. Additional Tanks (A 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) S <br /> 0.56 x Total N—J-- Tanks) J� <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 /> (B_ Temporary closures x $80) (See above V 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 sing tank . <br /> (® pf Permanent Closures x $90) 3O <br /> S. Plan Check Fee $30. <br /> Total Number of 'Tanks Total Fee Due <br /> Make all fees payable to. {Joa 0'i"n lotaT"HeaTth`Orstrict' 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) 5150 <br /> Ia. Existing Facility & 1st Tank 150 <br /> b. 3 Additional Tanks x $50 224 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> Total Number of Tanks 4 <br /> Total Fee Due $524 <br /> LA) <br /> ntat• su s ioned. Contact a Health District Represe <br /> Both clo - <br />