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_I FEE WORK-SHLET PER EACH FAC110 +� <br /> II FACILITY <br /> ORA.' ADDRESS i- <br /> •MAILING ADDRESS <br /> I . Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ 5150. <br /> b. Additional Tanks (d 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 Ianks) <br /> 3. "Temporary Closure (per tank) Underground Storage Tank in which <br /> s storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (l Temporary closures x $8O) (See above 13 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} ff, <br /> 5. Plan Check Fee 530. <br /> Total Number of Tanks Total Fee Due � C <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, I unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility 5 1st Tank $150 <br /> b. 3 Additional Tanks x S50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $57.4 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br />