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f(( WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DBA �J e— ADDRESS 2 i S d w. ci„o_i'- <br /> MAILING ADDRESS p.C>, gort 6zls S�°k�"' CA `' s2"` <br /> VQ <br /> 1. Operating Permit AppNOV �9g7 <br /> lication/Annual Inspection Fee -_ <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ Additional Tanks x $50) ENIERMIT/SERVICESTH <br /> F <br /> 2. State Surcharge (per tank) (Due with Permit Applications <br /> on renewal or amendment of operation permit and temporary closure) <br /> (156 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 /> (/_ Temporary closures x $80) (See above 03 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 /> (f? Permanent Closures x 190) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks <br /> Z Total Fee Due I <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. I waste oil ) <br /> Ia. Existing Facility 6 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 />