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FEE WORKSHLET PER EACH FACILIT` <br /> FACILITY <br /> DBA / jISa ( �( iF( ADDRESS �r� <br /> MAILING ADDRESS { <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (q 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 /> (d_ Temporary closures x $80) (See above k3 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 intentpA Y M E N T <br /> of re-using tank _ RECEIVED <br /> (k—L Permanent Closures x $90) NOV 4 1986 <br /> 5. Plan Check Fee $30. ENVIRONMENTAL HEALTH C?oANT <br /> PERMIT/SERVICES <br /> Total Number of Tanks Total Fee Due IDS <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 & 1st Tank $150 <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 $524 <br /> `Both closures will be conditioned. Contact a Health District Representative. <br /> -86 <br /> �T � I <br />