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FEE WORKSHEET PER EACH FACIU 0 . <br /> FACILITY <br /> DBA /40,/-Z ADDRESS //2�'i. S. <br /> ce <br /> MAILING ADDRESS_ O , 36 /0 / �©y� CA, 9S2eld <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (q 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 H 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 /> (M_ 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 owner/operator has no intent <br /> of re-using tank . OQ4 p?NF/2 2 7`�NKS OvFAI�- <br /> (N 2 Permanent Closures x $90) _ _ /P <br /> Q Oo <br /> 5. Plan Check Fee $30. b�T <br /> C/-/4-CK /Vo, 60/1P <br /> Total Number of Tanks ToJO IN% Due LtH /SaxENV10.0NM.��ERv1GE`� <br /> PERM I <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, l supreme, 1 waste oil ) <br /> Ia. Existing Facility & 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 wi_11 be conditioned. Contact a Health District Representative. <br />