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FEE WORKSHEET PER EACH FACILITY <br />DBA - �. <br />MAILING ADDRESS <br />FACILITYNo , -&�P,,AOORESS 3� <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (N Additional Tanks x $50) <br />2. State Surcharqe (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit andtemporary 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 />(f Temporary closures x $80) (See above N3 to calculate surcharge) <br />4. `Permanent Closure (per tank) Underground Storage Tank in which <br />storage has ceased and where the gwner/operator has no intent <br />of re -using tank. PAYMENT <br />(N � Permanent Closures x $90) RECIVED = <br />E <br />S. Plan Check Fee $30. DEC 7 1988 <br />tKVIRONMENTAt Nr "' %o ff <br />pERMITISER` J `1 <br />Total Number of Tanks Total Fee Due <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with your check. <br />�C'� cy- <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular. 1 unleaded. 1 supreme. 1 waste oil) <br />Ia. Existing Facility b 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />Total Fee Due <br />'doth closures will be conditioned. Contact a Health District <br />00-7-- , 1 <br />$150 <br />150 <br />224 <br />$524 <br />resentative. <br />