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FEE WORKSHEET PER EACH FACILITY FACILITY <br /> 1 (-nn--__ ADDRESS I� VA f�WL. <br /> OBA VA11 Ohl I C�r IV <br /> MAILING ADDRESS Q (rti�/dS Ie ��T°dJ �CA-- <br /> n <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. / 00 <br /> rc� <br /> b. Additional Tanks (N 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 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 /> (#_ 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 /> ([t Permanent Closures x $90) <br /> S. Plan Check <br /> �Fee $30. <br /> Total Number of Tanks <br /> Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> PAYMENT <br /> RECEIVED <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks DEC 2 0 7988 <br /> (1 regular. I unleaded, 1 supreme, 1 waste oil ) .ENVIRONMENTAL HEALTH <br /> Ia. Existing Facility 6 1st Tank $150 PERMIT/SERVICES . , <br /> b. 3 Additional Tanks x $50 <br /> 150 �-�)� <br /> 2. State Surcharge, 4 Tanks x $56 <br /> 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-t46 <br /> UGC � r <br />