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ILL WUKK�HLLI PER EACH FAC1L.%01 <br />Y <br />DBA % ADDRESSo17�� Guy <br />MAILING ADDRESS 0 / %7Z <br />19 Ve I9&7 <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. 1 FO SU <br />b. Additional Tanks (da 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 p 3 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 />(M _ 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-3— Permanent Closures x $90) — ✓4t'd 3/1V/88 7 �p <br />5. Plan Check Fee $30. <br />Total Number of Tanks 3 Total Fee Due A (p (p <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, I supreme, 1 waste oil) <br />la. Existing Facility & 1st Tank $150 <br />b. 3 Additional Tanks x $50 150 <br />2. State Surcharge, 4 Tanks x $56 224 <br />*Both <br />2-86 <br />Total Number of Tanks 4 <br />Total Fee Due $524 <br />res will be conditioned. Contact a Health District Representative. <br />140r <br />