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FEE WORKSHEET PER EACH FACILITY • <br />FACILITY <br />±L ADDRESS <br />MAII`NG ADDRESS ZA S 3 ` <br />1. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (N 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 />456 x Total N 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 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 />(N 7 Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks Z Total Fee Due <br />W `� J �� <br />Make all fees payable to San Joaquin Local Health District Enclose this wor et Q// <br />with your check, (�/�` C,(,• <br />EXAMPLE - Annual Fee for Facility with 4 Tanks 4 <br />(1 regular, l unleaded, 1 supreme, 1 waste oil) ` <br />la. Existing Facility 8 1st Tank $150 , <br />b. 3 Additional Tanks x $50�, <br />150 <br />2. State Surcharge, 4 Tanks x $56 224 le <br />Total Number of Tanks 4 Total Fee Due $524 <br />iV U0.ry F iZ <br />Both <br />osures will be conditioned Contact a Health District Representative. <br />