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FEE WORKSHEET PER EACH FACILITY 4 FACILITY <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) <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 /> (P_ Temporary closures x $80) (See above 03 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 /> 0 Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due l�— <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . (�k <br /> U ` V <br /> EXAMPLE - Annual Fee for Facilitywith 4 Tanks <br /> U� <br /> ( 1 regular, 1 unleaded, ] supreme, 1 waste oil ) <br /> Ia . Existing Facility & 1st Tank $150 I/ i <br /> b. 3 Additional Tanks x S50 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 /> 2-80 <br /> UCS ,41 <br />