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i <br /> FEE WORKSHEET PER EACH FAft 40 <br /> FACILITY , c <br /> DBAII+J PLL ) ADDRESS �JEvrA-i) " <br /> MAILING ADDRESS -- <br /> 1 . Operating Permit Application/Annual Inspection 'Fee <br /> a. First Tank at Facility (a S150. <br /> b, Additional Tanks (1' 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 /> (Z6 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 /> (1' Temporary closures x 180) (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 , <br /> ( # Permanent Closures x $90) PAYMENT <br /> 5. Plan Check Fee S30. RECEIVED -'�C) <br /> MAY 3 1 1980 <br /> Total Number of Tanks NvrRoNTAt 1LTH Total Fee Due a �� <br /> -- - ---__--'ERAA1TjSERVICES <br /> Make all fees payable to San Joa uin Local-Health District. Enclose this worksheet <br /> with your check . <br /> EKAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, l unleaded, l supreme , 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank 51b0 <br /> b. 3 Additional Tanks x S50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> `Both closures will be conditioned. Contact a Health District Representative. <br />