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fEE WORKSHEET PER EACH FACILITY <br /> DBA - � S6,13//1tS5' �f-ADORESSY <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 /> (556 x Total Bim_ 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 /3 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 /> (#I Permanent Closures x $90) Gf $ 6 1997 1 `/ <br /> 5. Plan Check Fee $30, 'd-/S0 / �L? <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, PAYMENTRECEIVED <br /> OCT 18 1988 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ENVIRONMENTAL HEALTH <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) PERMIT/SERVICES <br /> Ia . 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-+lG <br /> �� s <br />