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. I lb 0 <br /> FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DBA -4— <br /> t9` ADDRESS <br /> MAILING ADDRESS G7 crY. 3C? h 01t)—� <br /> I. New Faci l <br /> a. Firs nc $180. - -- <br /> b. Additional Tanks (#_ Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and Ist Tank @ $150. Q_'Q 4 <br /> b. Additional Tanks (#_ _ Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # / Tanks) <br /> 4. *Temporary Closure (per tank) Underground Storage Tank in whichr� <br /> storage has ceased but where the owner/operator proposes to ss <br /> re-use tank within 2 years. <br /> (# _ Temporary closures x $80) (See above #3 to calculate surcharge) <br /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $00) <br /> Total Number of Tanks / Total Fee Due <br /> Make all fees payable to San Joaouin 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 /> Ia. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 1,0 <br /> 2. State Surcharge, 4 Tanks x $56 224 <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 />