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FEE WORKMiLET PER EACH FACILITY <br /> _ FACILITY <br /> DBA 7 M {� � 2f ADDRESS / a5T ' S Crrn l ou' ewe <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (f 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 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 f3 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 f90) (1 <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due �O <br /> Make all fees payable to San Joaquin Local ealth District. Enclose this worksheet <br /> with your check . PAYMENT <br /> RECEIVED <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks SEP 211987 <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ENVIRONMENTAL HEALTH <br /> Ia. Existing facility b 1st Tank E150 <br /> PERMIT/SERVICES <br /> b. 3 Additional Tanks x $50 150 9 <br /> 2. State Surcharge, 4 Tanks x $56 224 dl � �� <br /> Total Number of Tanks 4 Total Fee Due $524 ll SEP 2 1. 1987 wj19- <br /> ENVIpumE.NTAL HEALTH <br /> ERfd1T/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-:;G <br />