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r tL wUKKbIiLL I PER EACH FACILI <br /> DBA FACILITY / <br /> ADDRESS <br /> MAILING ADDRESS <br /> I • Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. y <br /> b. Additional Tanks (V 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 <br /> (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) �A <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 /> (# Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks <br /> 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, i unleaded , 1 supreme , I waste oil ) <br /> la . Existinq Facility & Ist Tank 5150 <br /> h. 3 Additional Tank; x $50 150 <br /> {.'. State Surcharqe , 4 Tanks x S56 224 <br /> Tntal Number of Tanks 4 Total Fee Due 55?4 <br /> "Both closures will be conditioned. Contact a Health District Representative. <br /> Z-86 <br />