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FEE WORKSHEET PER EACH FACILII , - <br /> �rn FACILITY <br /> DBA Otto- (D;1 5+.4;, # ��ty ADDRESS 70-6,G-T&,,V <br /> MAILING ADDRESSZ4 /1? rjzwe'-t&/CIja �J% /U�l]J(��i aw <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 /> ($56 x Total M 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 /> (M_ 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 intent <br /> of re-using tank . <br /> (N_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. i <br /> Total Number of Tanks Total Fee Due io•oo <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, l supreme, 1 waste oi�1QJ��0 <br /> Ia. Existing Facility & 1st Tank "$150 <br /> ( u <br /> Q �G c u <br /> b. 3 Additional Tanks x $50 QON 1k(y� 1 <br /> 2. State Surcharge, 4 Tanks x $56EE4S <br /> Total Number of Tanks 4 Total9� e' `$524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-66 <br /> b <br />