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FEE WORK-SHEET PER EACH FACILITY <br /> FACILITY �^ <br /> OBA +1� '(` ADDRESS <br /> MAILING AOORESS�� C�Z`� 0 rA <br /> �R (J �`�T� ��� � <br /> '7172251; <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (f 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 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 M3 to calculate surcharge) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the gwner/operator has no intent <br /> of re-using tank _ ��oo <br /> (C ( Permanent Closures x $90) PAYMENT <br /> S. Plan Check Fee $30. RECEIVED <br /> OCT 19 1988 <br /> ENVIRONMENTAL <br /> Total Number of Tanks 3H Fee Due <br /> PERMIT/SERVICES <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 /> ( I regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility b 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 /> 2-86 <br /> UGT a I v <br />