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FEE WORKSHEET PER EACH FACILI� <br /> DBA (' .fj• �fI�/ � � ADDRESS <br /> Y � d lS✓ <br /> MAILING ADDRESS <br /> `4. Operating Permit.Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (A 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 p 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 /> (M_ Temporary closures x $80) (See above 13 to calculate surcharge) <br /> 4• `Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has cease; and where the owner/operator has no intent <br /> of re-using tank . <br /> (M__L Permanent Closures x $90) 90 <br /> S. Plan Check Fee $30. '" <br /> 01, <br /> 7 <br /> Total Number of Tanks Total Fee Due 00J <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 /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility 8 1st Tank 5150 <br /> h. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge,-4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> r <br /> *Both closures :,qill be conditioned. Contact a;Health District Representative. <br /> 2-86 . • <br /> U6`T a l <br />