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FEE uORKSHCET PER EACH FACILITY* <br />.FACILITY <br />ED <br />4 <br />MAILIN6 ADDRESS tEC - <br />1. Operating Permit Application/Annual inspection Fee <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (f 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 A 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 />(/. 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) <br />5. Plan Check Fee $30. <br />h <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 />PAYMENT <br />RECEIVED <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(I regular, 1 unleaded, I supreme, I waste oil) <br />Ia. Existing Facility b 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x S56 <br />Total Number of Tanks 4 <br />Total Fee Due <br />OCT 02 1987 <br />.ENVIRONMENTAL HEALTH <br />$150 PERMITJSERVICES <br />150 <br />224 <br />$524 <br />*Both closures will be conditioned. Contact a Health District Representative. <br />2 - 86 <br />