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FEE WORKSHEET PER EACH FACILIT <br /> FAC I L I TY ' <br /> ADDRESS 401 W. Kettleman Lane , Lodi <br /> DBA <br /> MAILING ADDRESS ��-� � • �R o�� � y <br /> 5 <br /> 1f New Facility or Addition <br /> a. First Tank $180. <br /> � s b. Additional Tanks (# Additional Tanks x $50) <br /> y P <br /> r 2° aaY Operating Permit Application/Annual Inspection Fee . h . <br /> a. Existing Facility and 1st Tank @ $150. . $ 150. 00 <br /> t �. <br /> . .f b. Additional Tanks (# 2 Additional Tanks x $50) <br /> "%---: State Surcharge (per tank) (Due with Permit Application, ; <br /> on renewal or amendment of operation permit and temporary closure) ' <br /> ($56 x Total # 3 Tanks) 16 8. 00 <br /> * Underground Storage Tank in which <br /> k <br /> 4. Temporary Closure (per tank) g g <br /> storage has ceased but where the owner/operator proposes to ; 4 <br /> re-use tank within 2 years. 1 � <br /> (# Temporary closures x $80) (See above #3 to calculate surcharge) <br /> 5. *Permanent Closure (per tank) Underground Storage Tank in which ,. <br /> ' Y S <br /> ` `storage has ceased and where the owner/operator has no intent , <br /> of re-usinq tank within next 2 years. Y �£ <br /> (# Permanent Closures x $90) <br /> # ? <br /> Total Number of Tanks 3 Total Fee Due, 418. 00 <br /> u <br /> �. - <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> .; <br /> $� <br /> h � <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ty <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 ` <br /> .j <br /> � b. 3 Additional Tanks x $50 150 � �# <br /> } el 2. State Surcharge, 4 Tanks x $56 .x 224 <br /> (y x <br /> Total Number of Tanks 4 � g Total Fee Due $524 i <br /> V, <br /> tit <br /> a'x , . <br /> *Both closures will be conditioned. Contact a Health District Representative. , <br /> 2-86 ` �m <br /> -. VA,A .F_„,b. ..a i.-td5 .-u .. ._.�5,.• t —_ _ _ u-C.1.�' o.'k_al '-'af2 ' rk.eA.:tM <br />