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FEE WORKSHEET PER EACH fACILITY • FACILITY • <br /> OBA 1 ��aiJ (tl W1aJt/(' L ADDRESS7�0 1 120 � Ttef) <br /> MAILfNG ADDRESS Sfl Y�F - <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (1 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 N 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 13 to. calculate surcharge) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the 9wner/operator has wAiY M t M T <br /> of re-using tank . RECEIVED <br /> X70,00 <br /> (#. Permanent Closures x $90) NOV 16 1988 <br /> 5. Plan Check Fee $30. ENVIRONMENTAL HEALTR <br /> PERMIT/SERVICES <br /> Total Number of Tanks <br /> 3 Total Fee Due a70, o--o <br /> Make all fees payable to San Joaquin Local Health District. 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 ) <br /> Ia. Existing Facility & lst Tank <br /> 5150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-26 • • <br /> G C--7 � f <br />