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FEE WORKSHEET PER EACH FACILIT. <br /> ��y � - FAC I L I TY- <br /> D8A <br /> 'yL � 1 A.5RESS, I V ;7 �tlr <br /> MAILING ADDRE- S Sir <br /> � S <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a, First Tank at Facility @ $150. <br /> b. Additional Tanks � r <br /> ( _ - Additional Tanks x $50) <br /> 2• State Surcharge (per tank) (Due with <br /> Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # - Tanks) <br /> 3• *Temporary CIO <br /> sure �7 <br /> (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> rc-usenk <br /> gal with6ln 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 /> ( 1 Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks !- <br /> Total Fee Due 312- G <br /> Make all fees --- <br /> payable to San Joa uin 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 $56 224 <br /> Total Number of Tanks 4 Total Fee Duepao <br /> DaW <br /> *Doth closures will be conditioned. Contact a Health Distr'c- Re eit-Ve <br /> 2-86 <br /> r <br />