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FEE WORKSHEET PER EACH FACILITY tqCrct,=T— ID <br /> FAC <br /> ILIT <br /> OBb AC -', �`;ADDRESSY <br /> � K3( (o • <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P 1150. <br /> b. Additional Tanks (M 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 03 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 /> (/__L Permanent Closures x $90) G <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. Aq <br /> 0 �cFM�Or <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ENR 19 <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) PFM FNP 9 <br /> la. Existing Facility & 1st Tank S150�SFRkc"11;"y <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 nv <br /> `Both closures will be conditioned. Contact a Health District Representative. <br /> 2-aG • • <br /> OC-7 it <br />