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# FEE WORKSHLET PER EACH FACILO <br /> . . , y FACILITY <br /> DBA:.' ADDRESS f <br /> MAILING ADDRESS /q/yz-W': <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ S150. <br /> b. Additional Tanks (N Additional Tanks x $50) n <br /> 2. State Surcharqe (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (SS6 x Total N /j 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 /> (N Temporary closures x $80) (See above N3 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 /> (! Permanent Closures x $90) PAYMENT <br /> 5. Plan Check Fee S30. RECEIVED -30 <br /> AUG I't 1988 <br /> Total Number of Tanks 'jyENVIRONMENTAL NEAL>fial Fee Due . <br /> PERMIT/SERVICES <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 b 1st Tank 5150 <br /> b. 3 Additional Tanks x S50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due 557.4 <br /> "Both closures will be conditioned. Contact a Health District Re rem sentative. <br /> c <br />