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FEE WORKSHEET PER EACH FACILITY *me / <br /> FACILITY <br /> DBA t ti r �t Q . c ielS�i� ADDRESS �p� <br /> MAILING ADDRESS <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 d 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 /> (A_ 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 , PAYMENT <br /> (R r) Permanent Closures x $90) RECEIVED �SYp <br /> 5. Plan Check Fee $30. MAR 041987 _ <br /> I5 'W1 ?�-( , <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Total Number of Tanks u Total Fee Due Sy l> <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 & 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-R6 <br /> ua-7 � I <br />