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FEE 'NCRK,SHEET PER EACH FACILITY <br /> FACILITY <br /> DRA - AJ Ay- � ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facilitv @ $159. 15c) <br /> b. Additional Tanks (/_2- 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 / 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 /> (/ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. R CE yep <br /> Nov 1,, 1986 <br /> Total Number of Tanks ? NVIRoAj, Total Fee Due <br /> PfRM17--ERV EsgL„H <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, 1 waste oil ) <br /> Ia. Existing Facility 8 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 /> EH 23 032 2/86 <br /> f <br />