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FEE WORKSHLET PER EACH FACI Y <br /> DBA % M� � FACILITADDRESSY /�Z <br /> MAILING ADDRESS S�j4 a_ <br /> TU /Gl+ '� 0 ice �✓ <br /> 1. Operating Permit Application/Annual nspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (d 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 /> (M_ Temporary closures x $80) (See above M3 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) � nLq <br /> S. P- � .; .; �' I o <br /> Total Number of TanksTotalI Q i p0 <br /> 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 /> 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 5524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-80 <br /> U(2-7 al <br />