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FEE WORKSHEET PER EACH FACILIJ <br /> 1 FACILITY <br /> OBA ,����-� L� i : (� ��'��- ADDRESS <br /> MAILING ADDRESS ,� eP0 U <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 /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 /> PAYMENT, <br /> of re-using tank . RECEIVED SU a� <br /> (N t Permanent Closures x $90) FEB 16 1998 <br /> 5. Plan Check Fee $30. <br /> .ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> ov <br /> Total Number of Tanks Total Fee Due O`-- <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, l unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 <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-t1G <br /> UGC al • <br />