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FEE WORKSHLET PER EACH FACILITY <br /> FACILITY <br /> DBA C ADDRESS <br /> MAILING ADDRESS D � <br /> 1. Operating Permit Application/Annual Inspection Fee p <br /> a. <br /> First Tank at Facility @ $151. <br /> b. Additional Tanks (#- ,�_ Additional Tanks x $50) MAR 3 )987 <br /> 2. State Surcharge (per tank) (Due with 'Permit Application, <br /> p rVER14 MER HEALTH <br /> on renewal or amendment of operation permit and tempo � VICES <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 #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 . <br /> (# Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> a0 <br /> Total Number of Tanks Total Fee Due <br /> Mae payable Make all fees a able to San Joaquin Local Health District. Enclose this workshee C - <br /> ) <br /> with your check. jb0 t� 10-9-')1eC7_&1V <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks MAR 03 1987 <br /> ( 1 regular, I unleaded, 1 supreme, 1 waste oil ) FNWRO <br /> Ia. Existing Facility 1 i ty & 1st Tank $15''JPE41 V� 1�{ ACTH <br /> � V7 <br /> Additional Tanks x $50 150 AL`S <br /> � 1 224 <br /> a2. tate Surcharge, 4 Tanks x $56 <br /> ��J7 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> SAN JOAQUIN COUP! '; <br /> GlPOLLUTION CONTROL DI-TRI- <br /> , J <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />