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r <br /> FEE WORKSHCET PER EACH FACILITY <br /> FACILITY <br /> DBA ffLv'/�1 S'c/� jrc %? ✓l! ADDRESS <br /> MAILIN6 ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (I 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 /> (156 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 /> (l.. 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 /> o/ re-using tank , <br /> (/ —�Z Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks / Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. 1P0 G /� k7l'7 % <br /> //(!�- 3a— Y7 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, I unleaded, 1 supreme, I waste oil ) <br /> Ia. Existing Facility b 1st Tank MO <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br />