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FEE WORKSHEET PER EACH FACIL•;Y1 <br />FACILITY <br />DBA f�Q 2 �a �y�y, ADDRESS <br />MAILING ADDRESS l %/ 7'I /1, <br />1. <br />New Facility or Addition <br />a. First Tank $180. <br />b. Additional Tanks (#_jAdditional Tanks x $50) <br />i <br />2. <br />Operating Permit Application/Annual Inspection Fee <br />a. Existing Facility and 1st Tank @ $150. <br />b. Additional Tanks (#_L Additional Tanks x $50) <br />3. <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary clo-ure) <br />($56 x Total # ranks) <br />-7_ <br />4. <br />*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 />5. <br />*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 within next 2 years. <br />(# Permanent Closures x $90) <br />4, 3(z: - -) <br />1/1 <br />Total Number of Tanks r�-' Total Fee Due <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 />la. 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 <br />Total Fee Due $524 <br />*Both closures will be conditioned. Contact a Health District Representative. <br />2-86 <br />