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FEE WORKSHEET PER EACH FA4Y S NE <br /> FACILITY _ <br /> DBA ADDRESS . !So! P.cEoY Or. ' <br /> MAILING ADDRESS (f)-7-V 1-44L,, Zcern X31 SC!4 95202 <br /> 1_ New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee . <br /> a. Existing Facility and 1st Tank @ $150. /50 <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 3_ State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total #_j Tanks) 5� <br /> 4. *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 #3 to calculate surcharge) <br /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks 1 Total Fee Due Zo G <br /> I',ke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> rich your check.' " <br /> EXAMPLE -. Annual Fee for Facility with 4 Tanks ) Tan(l regular, 1 unleaded, 1 supreme, 1 waste oil D <br /> Ia. Existing Facility & 1st Tank Ikrj 5150 <br /> li 444 2 g 196 <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 EIyVI{ )1ENTAL HEALTH ' <br /> Total Number of Tanks 4 } <br /> Total Fee Due 5524 <br /> IM <br /> `s <br /> -,; <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 2-86 0 <br /> • <br />