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FEE WORKSHEET PER EACH FACILITI :t <br /> DBA1. FACILITY HOUSTON SCHOr' <br /> LODI UNIFIED SCHOOL DISTRICT ADDRESS 4600 E. Acampo Road, Acampo, CA <br /> MAILING ADDRESS 815 W. Lockeford Street, Lodi , CA ATTN: Facility Planning <br /> 95241 <br /> I . Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 /> (N_ Temporary closures x $80) (See above M3 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 /> (H_1 Permanent Closures x $90) $ 90.00 <br /> 5. Plan Check Fee $30. egg_ <br /> Total Number of Tanks Total Fee Due <br /> B� <br /> Make all fees payable to San Joaquin Local Health District. Enclose this V*vh"N <br /> Or <br /> with your check . RECEIVED <br /> MAR 3 01987 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> ( 1 regular, 1 unleaded, 1 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 <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 /> pa-r of <br />