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1 <br /> {"ET E FA ITO <br /> FEE 4l0RKSl L PER EACs CIL <br /> FACILITY i <br /> DBA '— C� ) t. ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $151. <br /> b. Additional Tanks (q 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 H 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 #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 . 1P Ay X11 F t4T <br /> RE,GIVEt) <br /> Permanent Closures x $90) <br /> 5. Plan Check Fee $30. MAR U'4 1987 <br /> ENVIRONMENTAL� LTH <br /> �SERV4CE5 <br /> Total Number of Tanks <br /> 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 /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x. $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total dumber of Tanks 4 Total Fee Due $524 <br /> *Froth closures will be conditioned. Contact a Health District Representative. <br />