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FEE WORKSHEET PER EACH FAC-.-ITYIA ... <br /> / FACILITY cc <br /> DBA b k ADDRESS OI A <br /> MAILING ADDR SS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. Z oP <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 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 N3 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 /> (N Z--Permanent Closures x $90) 8 1 0 6 <br /> 5. Plan Check Fee $30. <br /> D� <br /> Total Number of Tanks Z-- Total Fee Due f Z <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 ff) ,n07 <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ENVIRUMEN1 AL HEALTH <br /> la. Existing Facility & 1st Tank $IERMIT/SERVICES <br /> b. 3 Additional Tanks x $50 150 2,1. VIZ <br /> 2. State Surcharge, 4 Tanks x $56 224 C 7 <br /> Ce l6jyi'6 <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 />