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FCC WORKSHEET PER EACH FACILITY \` <br /> � <br /> FACILITY <br /> OBA `/ `'� �t - ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. APR 3 C E9987 <br /> b. Additional Tanks (/ Additional Tanks x $50) ENVIROMENTAL HEALTH <br /> 2. State Surcharge (per tank) (Due with Permit Application, IER14IT/SERVICES <br /> on renewal or amendment of operation permit and temporary closure) <br /> (S56 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 /> (#— 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 /> (I Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks 1 Total Fee Due �� O <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 b lst 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 Oue $524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2 -XO <br />