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FLZHEET PER EACH FACILITY��'''�/�) fACILITY � <br /> UBA — J)AIr ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at facility @ $150. <br /> b. Additional Tanks 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 /> ($56x Total N S Tanks) �8d <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 /3 to. calculate surcharge) <br /> 4. "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the gwner/operator has no intent <br /> of re-using tank , <br /> (/_ Permanent Closures x $90) PAYMENT <br /> RECEIVED 0D' <br /> 5. Plan Check Fee $30. <br /> NOV o <br /> SENVIP�AteW <br /> Eft-eH <br /> Total Number of Tanks �16fl- <br /> RECEI VED <br /> Make all fees payable to San Joaquin Local Health DistriYO V &06QH this worksheet <br /> with your check. ENVIRONMENTAL HEALT14 L� <br /> PERMIT/SERVICES <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, I supreme, 1 waste oil ) <br /> Ia. Existing Facility 8 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-:.6 <br />