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FEE wORKSHLET PER EACH FACILITY • FACILITY p �; <br /> `" CZ <br /> DBA �i��G< ADDRESS <br /> MAILING ADDRESS <br /> G <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a, First Tank at Facility @ mfl. <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 /> (S56 x Total N Tanks) <br /> k) Underground Storage Tank in which <br /> 3. 'Temporary Closure (per tan <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 owner/operator has no int %J-� <br /> o1 re- sing tank , <br /> (# /,- Permanent Closures x $90) <br /> 5. Plan Check Fee $30. � <br /> Total Fee Due — <br /> Total Number of Tanks <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 /> 5150 <br /> Ia. Existing Facility 6 1st Tank 150 <br /> b. 3 Additional Tanks x $50 224 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> Total Number of Tanks 4 <br /> Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br />