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FCC uORKSHCET PER EACH FACILITY • <br /> FACILITY <br /> DBA k`70/V V&'17— /f, ADORE SS <br /> MAILIN6 ADDRESS P"A ,e,1. Operating Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ 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 /> (t56 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 /> h <br /> Total Number of Tanks Total Fee Duer <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . �EGV VEO <br /> t�G 81981 <br /> EXAMPLE - Annual Fee for Facility 4 Tanks N1Al HEA0A <br /> -- ty wENVIRONME SERVICES <br /> 0 regular, I unleaded, l supreme. I waste oil ) PERM <br /> la. Existing Facility b 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 /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> 2 -H6 <br />