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FEE wORKSHCET PER EACH FACILITY FACILITY <br /> 06A ADDRESS an� ISd F, m �o5o <br /> MAILINt ADDRESS 5a �n <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (I 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 f 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 f3 to. calculate surcharge) <br /> 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 /> (f 1 Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> 22ti <br /> 9� <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. PAYMENT <br /> RECEIVED <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> DEC 211987Y5 , <br /> ( I regular, I unleaded, 1 supreme. 1 waste oil ) ENVIRONMENTAL HEALTH <br /> la. Existing Facility 6 1st Tank <br /> $150 PERMITISERVICES <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks z $56 <br /> 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both Closures will be conditioned. Contact a Health District Representative. <br /> 2 <br />