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FEE WORKSHCET PER EACH FACILITY • _ FACILITY /� r <br /> DBA <br /> ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ 1150. <br /> b. Additional Tanks (1 . 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 1 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 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 /> (1_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> L� Total Fee Due <br /> Total Number of Tanks <br /> ' n Joaquin Local Health District. Enclose this worksheet <br /> Make all fees payable to Sa <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks C� <br /> (1 regular, l unleaded, 1 supreme. 1 waste oil ) $150 <br /> Ia. Existing Facility b 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 /> 2 -86 <br />