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rtt WURKSHItI PER EACH FACILITY <br /> ..AA /� � ��AA � FACILITY 9 r � <br /> DBA / j[ 4A -Pot ADDRESSNLD [nom fro, <br /> a <br /> MAILING ADDRESS SIA <br /> L Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150, , <br /> b. Additional Tanks,(/ - Additional Tanks x $50) <br /> 2. - State Surcharge (per tank) (Due with Permit Application, 0161- <br /> on <br /> /o6on renewal or amendment of operation permit and temporary closure) <br /> 456 x Total A 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 t3 to. calculate surcharge) <br /> - 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator hps no intent <br /> of re-using tank. <br /> 0 ( Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Ck 166 3 Z <br /> Total Number of Tanks � -----dotal Fee Due <br /> Make all fees payable to fan 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 & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br />