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FEE WORKSHEET PER EACH FACILITY ..i <br /> DBA N L . Q ;f CU. ADDRESSY7) Lt y <br /> ;i <br /> MAILING ADDRESS <br /> 1. 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 /> (S56 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 /> 0— Temporary closures x $80) (See above l3 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 /> (B Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due sio U <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet _0 <br /> with your check . <br /> C <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, I unleaded, 1 supreme, 1 waste oil ) PAYMENT <br /> Ia. Existing Facility & Ist Tank $150 RECEIVED <br /> b. 3 Additional Tanks x $50 150 SEP 2 6 1988 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> — ENVIRONMENTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $524 PERMITJSERVICES <br /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> 2-fl,6 <br /> UC--7 I - _ <br />