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FEE WORKSHEET PER EACH FACILI% <br /> FACILITY �f��oJJ <br /> DBA ADDRESS <br /> MAILING ADDRESS �`��' �_ � � c ��N � 7 �UQ�oC 9S3 �O <br /> i <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (d Additional Tanks x $50) 7� <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 x Total M Tanks) S� <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. 3� <br /> (I_ 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 /> 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 /> ( I regular, I unleaded, 1 supreme, I waste oil ) of <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 Number of Tanks 4 Total Fee Due $524 <br /> `Both closures will be conditioned. Contact a Health District Representative_ <br /> 2-ti6 <br /> UG- � � <br />