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FEE WORKSHLET PER EACH FACILITO FACILI I <br /> DBA �/ fi � S�vF�'//G�(� CiJfr'/ �' ADDRESS y o-2V'77 /V LC/16�1" STSCi9. 95 45 <br /> MAILING ADDRESS / PQ/ -R Si/eer 5�3c2/4�z,TZd // Y >� <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. P� U <br /> b. Additional Tanks (H -4�)- Additional Tanks x $50) g <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 R_I-- Tanks) S� <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 /> (M -) Temporary closures x $80) (See above N3 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 /> (b Q Permanent Closures x $90) 8- <br /> Plan Check Fee $30. <br /> a D(o• 00 <br /> Total Number of Tanks Total Fee Due 47@�) <br /> Make 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 /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & lst Tank $150 <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 $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />