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FEE WORKSHEET PER EACH FACILIT <br /> FACILITY r� <br /> DBA . �' ADDRESS <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) �51� <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 N2 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 #3 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 /> (kZ Permanent Closures x $90) POSTED BY <br /> 5. Plan Check Fee $30. SEP 2 3 Wb <br /> A/P. <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. &lose this tvoTrkshe'et <br /> with your check , P <br /> �i ,JUwI Wil.=J . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> Gni-CUS i OMER <br /> ( I regular, 1 unleaded, I supreme, 1 waste oil ) E #_ <br /> Ia. Existing Facility & Ist Tankri.$ —--- <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 2 <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 />