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FEE WORKSHEET PER EACH FACILITY • llNIS � SIS i <br /> ( RW <br /> FACILITY a � <br /> DBA 4� uey 7-(I.LC Cc7 i �UTiz( ( �i✓ —ADDRESS ��1 OLIVE !lyC -� SILS C,KTyy-): <br /> MAILING ADDRESS .a{grya <br /> 1. Operating Permit Application/Annual Inspection Fee $ 8� <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (0 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 M_ 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 N3 to calculate surcharge) � 7 <br /> 4. 'Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the 9wner/operator has no intent <br /> of re-using tank. <br /> (MI Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> to <br /> Total Number of Tanks Total Fee Due �96 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> PAYMENT <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks R E C EIV E D <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) AUG 2j )9igR <br /> Ia. Existing Facility & 1st Tank S15RNVIR0NMENTALHEALTH <br /> b. 3 Additional Tanks x $50 150 PERMIT/SERVICES <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> `00th closures will be conditioned. Contact a Health District Representative. <br /> 2-26 0 • <br /> UC7. '� f <br />