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FF- WORKSHLET PER EACH FACILITY <br /> DBA ? FACILITY <br /> ADDRESS <br /> MAILING ADDRESS <br /> r <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 b Tanks) <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to �`7 1►u 0 <br /> re-use tank within 2 years. 1,987(p_ Temporary closures x $80) (See above N3 to calculate surcharge) 3 <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which ENVIR <br /> 9OMENTAL HFAUH — <br /> PERMIT/SERVICES <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank . KNTy <br /> (#� Permanent Closures x $90) Ft9CEIVED a9U�o <br /> 5. Plan Check Fee $30. MAR V� 161 <br /> ENVIRONMENTAL HEALTH <br /> Total Number of Tanks PEY6ItA'Ve bue <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 6 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 /> *Bc h closures will be conditioned. Contact a Health District Representative. <br /> 2-f16 <br />