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' WORK-SHEET PER EACH FACILITY • • <br /> _ fACIIITY <br /> C. i�31 r S._H A� S4V. C A <br /> �-� ADORES$ -- -- <br /> .INS ADDRESS <br /> Operating Permit Application/Annual Inspection Fee <br /> ' a. First Tank at Facility a $150. <br /> b. Additional Tanks (f Additional Tanks x $50) <br /> State Surcharge (per tank) (Due with Permit Application. <br /> on renewal or amendment of operation permit and temporary closure) <br /> ' (f56 x Total / Tanks) <br /> *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 /> *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 /> ENS <br /> .IM L CEO <br /> Q <br /> ' (1? Permanent Closures x 190) GE _ <br /> t; 111g�1 r <br /> Pian Check Fee $ao. <br /> ' Z Total FA Due <br /> -411 rro.o' <br /> Total Number of Tanks <br /> ke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> th your check. <br /> ' EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( i regular, 1 unleaded, 1 supreme, I waste oil) <br /> Ia. Existing Facility b 1st Tank 5150 <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 $514 <br /> ' Doth closures will be conditioned. Contact a Health District Representative. <br />