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FEE. WORKSHLET PER EACH FACILIIY <br /> FACILITY <br /> OBA ADDRESSR <br /> MAILING.ADDRESS S, - <br /> 1. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks 0 Additional Tanks x $50) <br /> 2. State Surcharqe (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (5,56 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 /> (# 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 gwner/operator has no intent <br /> of re-using tank . <br /> PAYMENT <br /> 0 Permanent Closures x $90) RECEIVE'? <br /> 5. Plan Check Fee $30. _9EC 7 <br /> Total Number of Tanks ` PERIu1T�t �ly� Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . ���t� <br /> —OF <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular, 1 unleaded, I supreme . I waste oily <br /> la. Existing Facility & 1st Tank 5150 <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 /> *Both closures will be conditioned. Contact a Health District Representative_ <br /> �c r • <br /> 0 <br />