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EE wOVSK ET PER EACH fACILITY .. <br />FACILITY .r v <br />:iA' Mies JAIDF,0c01V ADDRESS 1 �2 4/ U SrC�'FT <br />4AILING ADDRESS 19G/ �L1cA(7-1eCAL6� s>cr C,4 91 <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ S150. <br />b. Additional Tanks (I Additional Tanks x $50) <br />2. State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit andtemporary closure) <br />(156 x Total A 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 />(f_ Temporary closures x $80) (See above f3 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 />(f/ Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks CAI <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) $150 <br />Ia. Existing Facility 6 1st Tank <br />b. 3 Additional Tanks x 150 150 <br />1. State Surcharge, 4 Tanks x S56 224 <br />Total Number of Tanks 4 <br />Total Fee Due 1524 <br />*Both closures will be conditioned. Contact a Health District R!Rresentative. <br />2-R6 <br />