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FEE WORKSHEET PER EACH FACILITY <br /> ACILITY <br /> OBAUL✓�U Cf/j�yycc� 1DORESS <br /> MAILNG ADDRESS Q� S �/t/1.tT'�d S21� CAY.�t.G <br /> o% <br /> 1. Operating Permit Application/Annual Inspection Fee C� + <br /> 6 c__ <br /> a. First Tank at Facility P $150. '200 t Zoo <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 /> (I_ 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 gwner/operator has no intent <br /> of re-using tank , <br /> (I—ze:-Permanent Closures x $90) <br /> S. Plan Check Fee $30. ll <br /> Total Number of Tanks Total Fee Due ` <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> K <br /> C <br /> PAYMENT <br /> with your check, RECEIVED <br /> AUG 51989 ck <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks �p \0� <br /> ENVIRONMENTAL HEALTH <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) PERMIT/SERVICES <br /> Ia. Existing Facility & 1st Tank 5150 <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 5524 <br /> `Both closures will be conditioned. Contact a Health District Representative. <br /> 2 <br /> UCS al <br />