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FEE WORK-SHEET PER EACH FACILITY • FACILITY <br /> 08A <br /> ADDRESS %I Fin s` �� i xt J� ✓TIC/� <br /> �dbi�/.L� � ''� ��id�lr,(/�.� �j¢�4 r <br /> MAILING ADDRESS `t)O tL <br /> 1. Operating Permit Application/Annual InspecttC' _r <br /> a. First Tank at Facility @ $150�t2 <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 0 / 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. r— <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 /> Permanent Closures x $90) _ <br /> 5. Plan Check Fee $30. <br /> Total Fee Due <br /> Total Number of Tanks <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> P E <br /> �P <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme. 1 waste oil ) $150 <br /> Ia. Existing Facility 6 1st Tank <br /> b. 3 Additional Tanks x $50 <br /> 150 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> 224 <br /> Total Number of Tanks 4 <br /> Total Fee Due 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2 -ISG <br />