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FEE NORKSHCET HER EACH FACIIi <br /> FACILITY 2575 CON CLUBBOULEVARD <br /> e, <br /> A SMELL, OIL COMPANY ADDRESS SrOCKTION, CA 95204 <br /> - - MAILING ADDRESS p-O• BOX 13678, SACRAMENTO, CA 95853 <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility p $150. N/A <br /> b. Additional Tanks U Additional Tanks x $50) N/A <br /> 2. State Surcharqe (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> N/A <br /> 456 x Total M 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 /> (N Temporary closures x $80) (See above M3 to calculate surcharge) N/A <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no inte , <br /> of re-using tank . RECD vNT <br /> Ep <br /> 0 Permanent Closures x $90) F � N/A <br /> 5. Plan Check Fee $30. ENVIRON $30.00 <br /> PE MENTAL HEALTH <br /> RMIT/SERVICES <br /> Total Number of Tanks EXISTING; Total Fee Due $30.00 <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 /> ( I regular. 1 unleaded. 1 supreme. I waste oil ) <br /> Ia. Existing Facility b lst Tank $ISO <br /> b. 3 Additional Tanks x $50 ISO <br /> 2. State Surcharge. 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due S524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> L _ <br /> 2-fIG <br />