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FEE WORKSHEET PER EACH FACILITY (p4 <br /> FACILITY S( <br /> DBA _ ADDRESS ( �(0 �C 0. I �• /�r 1n <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (1' 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 M 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 /> (I_ 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 hf§aT intent N T <br /> of re-using tank , RECEIVED <br /> (f_ Permanent Closures x $90) NOV 2 8 1988 <br /> 5. Plan Check Fee $30. ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <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 /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular, 1 unleaded, 1 supreme. 1 waste oil ) <br /> Ia. Existing Facility 8 1st Tank 5150 <br /> b. 3 Additional Tanks x $50 150 �y <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 IIIJA_� <br /> 'doth closures will be conditioned. Contact a Health District Representative. <br /> 7-8G <br />