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FEE WORKSHEET PER EACH FACILITIOM <br /> FACILITY <br /> DBA J/} A4Fj [4L-L -}— 1N F 5—ADDRESS <br /> MAILING ADDRESS Z 2 3 Z J-7c?F tNJoV7 <br /> 1. Operating Permit Application/Annual Inspection Fee n � <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> EP 10 196 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary Ej'bsu;r,��rJAL HEALTH <br /> ($56 x Total # Tanks) FEIi:411Y/SERVICES, <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 /> (#- Permanent Closures x $90) O Q~ <br /> 5. Plan 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, 1 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 /> -86 <br />