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FEE WORKSHEET PER EACH FACILITO • <br /> // FACILITY ' D <br /> DBA <br /> ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> /-50 <br /> a. First Tank at Facility @ $150. <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 /> ($56 x Total H / _ Tanks) (3. *Temporary*Temporary Closure (per tank) Underground Storage Tank in which L�^^ <br /> storage has ceased but where the owner/operator proposes to <br /> flank wi'thin 11 <br /> re-use tank U � years. <br /> (y Temporary closures x $80) (See above N3 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 /> (H_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> ENVIRONMENTAL HEALTH <br /> ff PERMIT/SERVICES 60 <br /> Total Number of Tanks I Total Fee Due 6 <br /> Make all fees payable to San Joaquin Local Health District. Enclose thisF I* EffWT <br /> RECEIVED <br /> with your check. <br /> JAN 27 )Jb <br /> .ENVIRONMENTAL HEALTH <br /> EXAMPLE- Annual Fee for Facility with 4 Tanks PERMITISERVICES <br /> (1 regular, 1 unleaded, 1 supreme, 1 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 $524 <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 2-86 • • <br />