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FEE WORKSHEET PER EACH FACIL1% <br /> FACILITY <br /> DBA _ &'/j��GJI y)ie-ADDRESS 70/ J- <br /> 4MAILING ADDRESS O <br /> B�k�s r9�7 <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 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 /> (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 in t <br /> of re-using tank . <br /> (N Permanent Closures x $90) �� <br /> 5. Plan Check Fee $30. q <br /> r G` <br /> Total Number <br /> �o�f�/Tanks Total Fee Due SG � <br /> �% _ ��.,> �����7 <br /> Make all fees payable to an 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 & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-B6 <br /> UGC al <br />