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r1l WORKSHEET PER EACH FACILLII�TY 44 <br /> /��O�Tf� �. ( STIICPLDM RESSY <br /> DBA <br /> 'AILING ADDRESS <br /> I . Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. Q- <br /> b. Additional Tanks (/ 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 /> (156 x Total I 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 I3 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 , PA <br /> (I - / Permanent Closures x $90) RECEIVeo <br /> ma <br /> 5. Plan Check Fee $30. OCT ? 7 <br /> 1989 <br /> -ENVIRONMENT <br /> PERMITISERVI CES Total <br /> Total Fee Due 9O — <br /> Total Humber of Tanks <br /> Hake all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular, I unleaded, 1 supreme, I waste oil ) <br /> Ia. Existing Facility b 1st Tank $150 � ��� Y <br /> b. 3 Additional Tanks x 150 150 <br /> 2. State Surcharge, 4 Tanks x 156 224 <br /> Total Number of Tanks 4 Total Fee Due 1524 <br /> • <br /> 'Both Closures will be conditioned. Contact a health Districs R presentative. <br />