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FEE WORKSHEET PER EACH FACILITY <br /> 0 FACILITY <br /> DBA (�c,�e , - _� ADDRESS <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (0 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 03 to calculate surcharge) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the gwner/operator has no intent <br /> of re-using tank _ <br /> (N Permanent Closures x $90) FAYMEt4T <br /> RECEIVED <br /> 5. Plan Check Fee $30. <br /> OCT 13 1988 <br /> .ENVIRONMENTAL HEALTH <br /> Total Dumber of Tanks PERMIT f `jj__Eee 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, 1 unleaded, 1 supreme, I waste oil ) <br /> Ia. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $SO 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 /> UaT <br />