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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DPA <br /> � ��� , P ADDRESS <br /> MAILING ADDRESS <br /> I- 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 M 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 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� Permanent Closures x $90) PAYMENT qO <br /> 5. Plan Check Fee $30. RECEIVED <br /> JUL 13 1988 <br /> Total Number of Tanks ENViR SIT/SERIMENTAL HEA�Thbtal Fee Due <br /> PE /SERVICES <br /> ��ACK <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 /> la. Existing Facility & 1st Tank 5150 <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 /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-H6 <br /> UcT ar <br />