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,PoP <br /> FEE WORKSHCET PER EACH FACILITY41 <br /> FACILITY <br /> DBP; U f' S70 c k-?cn ADDRESS `•-'U C d�'y <br /> MAI LINT",-ADDRESS f f G - d <br /> Operating Permit Application/Annual Inspection Fee �o <br /> 1. Ope g p 5 <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (#- Additional Tanks x 550) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) �� <br /> 4.56 x Total N- 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 /> (I 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 /> (0 Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> PAYMENT <br /> RECEIVED Total <br /> � - <br /> Total Number of Tanks Tata{ Fee Due <br /> DEC 131988 <br /> )+WRONMEhfTAL HEALTH <br /> Make all fees payable to San Joaquin Local HABUT03MRS. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular, I unleaded, 1 supreme. 1 waste oily <br /> Ia. Existing Facility b Ist Tank 1;15(1 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, <br /> 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee flue $524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> UC- � r <br />