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FEE WORK-SHEET PER EACH FACILITY <br /> FACILITY Physical Plant <br /> DBA UNj_VEBS.IT AF_._j_HF pMFT(' ADDRESS_ 1081 West Mendocino Stkn, Ca 95211_ <br /> MAILING ADDRESS SAME <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. $ Q <br /> 5. Additional Tanks (# 1 Additional Tanks x $50) 50.00 <br /> 3. State Surcharqe (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> 1($56 x Total # 2 Tanks) 112.00 <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 2 Total Fee Due $312.00 <br /> Make all 'fees payable to Can joaquin Local Health D4ctrl ct. Encv .a w thisJ worksheet <br /> with your check. ' <br /> EXAMPLE Annual Fee for Facility with 4 Tanks <br /> 0 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing 'Facility & Ist Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Humber of Tanks 4 Total Fee Dine $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />