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FEE WORKSHEET PER EACH FACIPY <br /> DBA t <br /> FACILITY <br /> 'C�C, IP/t �fa( ) ADDRESS <br /> MAILING ADDRESS 51,4-- <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ 5150. <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 /> (556 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 /> (1_ Temporary closures x $80) (See above l3 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 /> (I Permanent Closures x $90) PAYMENT <br /> RECEIVED <br /> 5. Plan Check Fee 530. � <br /> SEP <br /> .ENVIRONMENTAL HEALTH�� <br /> Total Number of Tanks PERMIT/SERVICES ter Due <br /> - 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, I unleaded, 1 supreme, I waste oil ) <br /> Ia. 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 552.4 <br /> .Both closures will be conditioned. Contact a Health District Representative. <br /> 2-26 <br />