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FEE WORKSHEET PER EACH FACILITY V07FACILITY <br /> ew, <br /> DBA 1'l� L CeR.v�/�ft�% �AX7'ci ADDRESS /;7/�f �TC04,9�7.sa <br /> MAILING ADDRESS p � ) '7�g, ST i C� '75-20 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (f 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 M 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 /> (d_ Temporary closures x $80) (See above l3 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 /> 0 / Permanent Closures x $90) 0 <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 /> RA <br /> Vgpr <br /> EXAMPLE - Annual Fee for Faci 1 i ty wi th 4 Tanks �rlti�lY <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) FNVIRONMtNjrk <br /> Ia. Existing Facility & 1st Tank $150 PERMIVSERV, HEAL-rH <br /> b. 3 Additional Tanks x $50 150 ES <br /> 2. State Surcharge, 4 Tanks x $56 224 (HCl <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-R6 • 0 <br /> OC--7 z2 <br />