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F.EE WORKSHEET PER EACH FACILII1 <br /> DBA KEIR KRANE, INC. FACILITY <br /> ADDRESS 110 Beard Ave. , Modesto, CA <br /> MAILING ADDRESS 110 Beard Ave. , Modesto, CA 95354 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (q 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 N 1 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 /> R_ Temporary closures x $80) (See above 83 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 /> (k_L Permanent Closures x $90) 90 <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks 1 Total Fee Due 9Q, <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksheet V+, <br /> with your check. <br /> \AGN, i <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 <br /> 1). 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 /> fiG <br /> G+eT a1 <br />