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46 0 <br /> FEE 'WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DHA ' L _ ADDRESS ? G7 'J fu S <br /> MAILING ADDRESS t?�a, Z`f b CoN ,D `e <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# i Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewai or amendment of aperai.ion perviiit and temporary closure) <br /> ($56 x Total # 2- Tanks) 1 <br /> 4. *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 /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks r 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 <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 ,' <br /> b, 3 Additional Tanks x $50 <br /> 15 0,;!,, <br /> 2. State Surcharge, 4 Tanks x $56 224 MAR 2 Wo <br /> NVIROMENTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $52 PER MIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 ' <br />