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FEE WORK-SHEET PER EACH FACILIIi • <br /> FACILITY ' I <br /> DBP. fJ«� ADDRESS v w(}L#/J1 AV V <br /> -MAILING ADDRESS `3991m � o�s TVQ �oC✓� C� 9S3 $O <br /> 1. _Operating)."Permlt_ ApplIcation/Annual Inspection Fee o ° ; <br /> a. first Tank at Facility N $150. <br /> b. Additional Tanks (/ Additional Tanks x $50) —5-a <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 / 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 I3 to calculate surcharge) <br /> 4. 'Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and whereithe owner/operator has no intent : <br /> of re-using tank. C <br /> (/I Permanent Closures x $90) ¢ 7J <br /> S. 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 /> ( 1 regular, l unleaded, 1 supreme. 1 waste oil ) <br /> Ia. Existing Facility 6 1st Tank $150 I.�o <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-iS6 • • <br /> T . <br />