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FEE WORKSHEET PER EACH FACILI44. <br /> - FACILITY <br /> DBAADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. LSD <br /> b. Additional Tanks (# Z Additional Tanks x $50) /QD <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or endment of operation permit and temporary closure) <br /> ($56 x Total Tanks) 6g� <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 /> (#,O� 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 /> (# q Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks 3 Total Fee Due <br /> �D ass iola�� <br /> GKl*ur�l6 � (8� �(a��f57 (80 <br /> Make all fees payable to San Joaquin Local Health District. Enclose tis 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 /> Ia. Existing Facility & 1st Tank $150 � ) 8 <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 <�33frti�s� <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> GG"T- <br /> a r • • <br />