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FEE WORKSHEET PER EACH FACILI� • <br /> n, FACILITY <br /> DBA n �v , �W� U <br /> ADDRESS S VCw� W��� Cry Xay� <br /> MAILING ADDRESS Sa(p eQ c >�� / <br /> 1. Operating Permit Application/Annual Inspection Fee <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 # 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 " PAYMENT <br /> RECEIVED o8 <br /> (#__L Permanent Closures x $90) <br /> FEB 1967 <br /> 5. Plan Check Fee $30. <br /> 3 <br /> ENVIPO MITETH <br /> ISERVICES <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 /> EXAMPLE Annual Fee for Facility with 4 Tanks FE tj <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ENVIROMENTAL HEALTH <br /> Ia. Existing Facility & 1st Tank tfWIT/SERVICES <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 />