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FEE WORKSHEET PER EACH FACILITO • <br />FACILITY WOODBRIDGE S&HOOL <br />DBA LODI UNIFIED SCHOOL DISTRICT ADDRESS 18500 Lilac Street, Woodbridge <br />MAILING ADDRESS 815 W. Lockeford Street, Lodi, CA 95241 ATTN: Facility Planning <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 Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary closure) <br />($56 x Total H 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 />(p 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 owner/operator has no intent <br />of re -using tank_ <br />(q_L Permanent Closures x $90) $ 90.00 <br />5. Plan Check Fee $30. <br />Total Number of Tanks <br />Make all fees payable to San <br />with your check. <br />Total Fee Due <br />uin Local Health District. Enclose this worksheet <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, 1 waste oil) <br />Ia. Existing Facility & 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 Total Fee Due <br />*Both closures will be conditioned. Contact a Health District Re <br />2-86 <br />061- a f <br />PAYMENT <br />RECEIVED <br />MAR 3 0198 <br />.ENVIRONMENTAL HEALTH <br />$150 PERMIT/SERVICES <br />150 <br />224 <br />$524 <br />sentative. <br />