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FEE WORKSHLET PER EACH FACILI 6 <br /> DBA FACILITY <br /> ADDRESS <br /> t t , <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (# 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 p Tanks) ` -N <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 /> (p_ 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 /> (M Permanent Closures x $90) <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. �b <br /> . . .... .. ......., <br /> EXAMPLE - Annual Fee for Facility with 4 Tanksr <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ,f. r <br /> Ia. Existing Facility & 1st Tank $150 1 q g—7 <br /> b. 3 Additional Tanks x $50 150 j <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 /> -!i6 <br /> UGT a t <br />