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FEE WORK-SHEET PER EACH FACILITY • <br /> fACT LITY �1 �j-- <br /> DBAv 'p � o . ydUG/ /{lilcv �tK�AODRESS (IDIIn �" dC <br /> i <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (r 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 (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 03 to calculate surcharge) <br /> 4. "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the qwner/operator has no intent <br /> of re-using tank , <br /> (l_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. 7aA*v Alf'"""c / �J <br /> -5 � <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 . PAYMENT <br /> RECEIVED <br /> AUG 91�0`� <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ENVIRONMENTAL HEALTH <br /> ( 1 regular. 1 unleaded, 1 supreme, 1 waste oil ) PERMITISERVICES <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 Due $524 <br /> *Both Closures will be conditioned. Contact a Health District Representative. <br /> 2-,iG • • <br /> UGC a1 <br />