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FEE WORKSHEET PER EACH FACiLI <br />FACILITY <br />DBA MKS ADDRESS <br />MAILING ADDRESS ;2 (a l i',�c-Y)tj 61((- <br />1. Operating Permit Application/Annual Inspection Fee <BU <3-7 cd ?, <br />a. First Tank at Facility @ $150. 1660 15O 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 M 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 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. <br />(N Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks <br />Total Fee Due <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 />1). 3 Additional Tanks x $50 150 <br />2. State Surcharge, 4 Tanks x $56 224 <br />Tnril Number of Tanks 4 Total Fee Due 5524 <br />'Both closures will be conditioned. Contact a health District Representative. <br />2 -tib <br />