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FEE t SHEETPER EACH FACILITY <br /> 4, FACILITY7e <br /> DBA DRESS <br /> MAILING ADDRESS® <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/_ IAdditional Tanks x $50) 88Z <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 /�_ 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/operatorrhas ° . <br /> of re-using tank . <br /> (/ Permanent Closures x $90) <br /> IND <br /> 5. Plan Check Fee $30, HLA Tl <br /> Total Number of Tanks . Total Fee Due <br /> / �cc L-At'4_011N <br /> \ ' Y <br /> 00 <br /> payable to San Joaquin local Health District. Enclose this worksheet <br /> — <br /> Make all fees` Lc irr <br /> with your check <br /> A ,q <br /> 7,4 <br /> EXAMPLE - Annual Fee r foFacility d � <br /> Facili with 4 Tanks <br /> ; <br /> . 8 <br /> bA/ <br /> (1 regular, -1„ unleaded, I supreme,- I waste oil ) r # <br /> b <br /> aas 4 � Ia �< Existin9 Facility b lst <br /> Tank 5150 <br /> „i b. � �3 Additional Tanks x $50 <br /> 2. State Surcharge. 4 Tanks x SS6 224 <br /> r <br /> Total Numberof :Tanks 4 Total Fee Due S524 <br /> x, <br /> k 'Both closures will be conditioned. Contact a tiealth District Representative. <br /> 2-:;G <br />