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FEE GOR.'•SHCET PER EACH FACILITY <br /> 0 FACILITY <br /> - <br /> DBA I ADDRESS :Z 21 1 <br /> MAILING ADDRESS 74 ul'vg S'-f- <br /> o(Cj c <br /> 1. � o <br /> Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility A $150. <br /> b. Additional Tanks (0 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 1 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 $8O) (See above x3 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, I "f es r k- Gj('C a C f o'se j -- Ke-rulio( <br /> C� <br /> (M 3 Permanent Closures x S9O) �7 <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due <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, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & ist Tank 5150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Humber of Tanks 4 Total Fee Due $524 <br /> `Both closures will be conditioned. Contact a Health District Representative. <br /> EH 23 032 2/86 <br />