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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY If lv � VV7--4 C'Lv� 5� <br /> DBA /II l/ JG �L— ADDRESS <br /> MAILING ADDRESS IC )l f/ <br /> e4NIP o L/ <br /> 1. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (M 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 M Tanks) <br /> 3. 'Temporary Closure (per tank) Underground Storage Tank in which ' � <br /> NOV 1 <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. 071 <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 /> (d Permanent Closures x $90) y Z_ <br /> S. Plan Check Fee $30, c <br /> Total Number of Tanks Total Fee Due �/ v`0 o <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, l 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 V 1 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> UC---7 <br />