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• I,, ICK[ I LL <br /> FEE WORKSHEET PER EACH FACILITO �8'l <br /> // <br /> FACILITY p E <br /> DBA ADDRESS <br /> MAILING ADDRESS IN dJ <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $ISO. <br /> b. Additional Tanks (M 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 /3 to calculate surcharge) <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 /> (M� Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks j Total Fee Due <br /> v% <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, l unleaded, 1 supreme. 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $S0 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> 1101-7 IQ <br />