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FEE WORKSHCET PER EACH FACILITY a <br /> FACILITY <br /> 09A AOORESS 12 < <i 1,. . t Q4.- S t =.4 Sa z�3 <br /> MAILING AODRESS Rc, l -iztr r S4aoi - -- 4 S'zok <br /> 537iAb35�11Wb3d <br /> 4111VIH 1d1N3WNOVANI <br /> 1. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ $150. �86� �� <br /> b. Additional Tanks (N Additional Tanks x $50) a9At303a <br /> 2. State Surcharge (per tank) (Due with Permit Application. <br /> ,LNli W JlV d <br /> on renewal or amendment of operation permit and temporary closure) PAYMENT <br /> ($56x Total N Tanks) RECEIVED <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which `1'� OCT 2 6 1987 <br /> storage has ceased but where the owner/operator proposes to `el <br /> ENVIRONMENTAL HEALTH <br /> re-use tank within 2 years. PERMITISERVICES <br /> (0, Temporary closures x $80) (See above 03 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 /> (/ Z Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> -H ) <br /> Total Number of Tanks Z #i Total Fee Due 1F = <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 b 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 5524 <br /> 'Doth closures will be conditioned. Contact a_ Health District Representative. <br /> 2 0 0 <br />