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FEE WORKSHEET PER EACH FACILITY <br /> \ I� �/�� FACILITY <br /> DBA 1J 01� DNiiZI�4(11d-T�7�rg/� �yGb1td< ADDRESS TOC�IOX/ <br /> MAILING ADDRESS1lll�'4 ���� ZEE=� lylac� <br /> t�- <br /> 1. Operating Permit Application/Annual Inspection Feed <br /> a. First Tank at Facility @ $150. IS( <br /> b. Additional Tanks (f 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 N ! 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 f3 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) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due a86� <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet q3� <br /> with your check . n a <br /> 1� 1 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility 6 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <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 -;.r, <br />