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rtt WURKSHLLI PER EACH FACILITY— <br /> FACILITY <br /> OBA —f��nerl�«r AADDRESS <br /> MAILING ADDRESS Z- <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N I Additional Tanks x $50) Vnlpu(RFci SOC) c SO <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) 105 <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 /> (M_ 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 /> (N r Permanent Closures x $90) PAYMENT 9cJ <br /> — RECEIVED <br /> 5. Plan Check Fee $30. - <br /> SEP 14 1989 <br /> WWONMENTAL HEALTH <br /> Total Number of Tanks I PERMIT/SERVICESTotal Fee Due a � cl� <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 /> ( 1 regular, 1 unleaded, 1 supreme, I 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 /> 2-86 <br /> UST al <br />