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fEE WORKiSHEET PER EACH FACILITY . • <br /> DBA <br /> FACILITY <br /> /� /G�/yit c,c� 9' �!e� ADDRESS <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection fee <br /> a. first Tank at Facility @ $150. <br /> b. Additional Tanks (/ 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 /> 456 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 /> (I _ Temporary closures x $80) (See above 13 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 /> (l� Permanent Closures x $90) �G1 <br /> 5. Pian 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, <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded , l 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 /> Total Number of Tanks 4 Total Fee Due $524 <br /> ^Both closures will be conditioned. Contact a Health District Representative. <br /> 2 <br /> UCS -,2l <br />