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rEE WORKSHEET PER EACH FACILITY* <br /> FACILITY <br /> DBA <br /> .7�✓ic2�t <br /> MAILING ADDRESS C /1— <br /> I. <br /> 1 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N Additional Tanks x $50) /9 f 7 �a <br /> 2. State Surcharge (per tank) (Due with Permit Application, / 15 <br /> Geesu,ee <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 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 /> (f_ 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 /> of re-using tank , <br /> (NPermanent Closures x $90) O <br /> 5. Plan Check Fee $30, <br /> /� OG <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 /> I <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ENVIRONMENTAL HEALTH <br /> la. Existing Facility & 1st Tank $150 PERMIT/SERVICES <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 /> *Doth closures will be conditioned. Contact a Health District Representative. <br /> UGC � 1 <br />