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FEE WORKSHEET PER EACH FACILII" <br />FACILITY <br />DBA ADDRESS <br />MAILING ADDRESS <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (M /_ Additional Tanks x $50) S C3 <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 />(#_ 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 />(R Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks ;" T� (� <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet 'A��� <br />a <br />with your check. <br />S(Lyst % <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, I 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 />2-26 <br />UG"r a I <br />