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FEE WORKSHLLT PER EACH FACILITY 0 <br /> �1 1 FACILITY rt ,t/�I <br /> DBA JtcCj<Ssti VU IC �C ri�c( ADDRESS I/Is G- /��l •te'r 5+�� <br /> MAILING ADDRESS <br /> 1 . Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. 1,50 <br /> b. Additional Tanks (q 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 #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 . PAYMENT <br /> (# Permanent Closures x $90) RECEIVED <br /> S. Plan Check Fee $30. NOV 17 1W, <br /> ENVIRONMENTAL 14@ALTH <br /> PERMIT' SS�� <br /> Total Number of Tanks Total Fee/Uu�I�ES <br /> r <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 /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge , 4 Tanks x $56 224 <br /> Total Numher of Tanks -4- Total Fee Due $524 <br /> "doth closures will be conditioned. Contact a Heal_th_ District Representative. <br /> 2-HG <br /> 0�?,"7 a 1 <br />