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r CC WUKA•J11Lt 1 PER EACH FACT LI <br /> J6 FACILITY <br /> DBA aooREss Sri <br /> LING ADDRESS S ,✓J <br /> I. Operating Permit Application/Annual Inspection Fee 057 7 <br /> a. First Tank at Facility @ $150. j <br /> b., Additional Tanks 0Additional Tanks x $50) <br /> 2• State Surchar e (per tank) (Due with Permit <br /> Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # -:?> 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 /> (N Temporaryclosures x $80) (See above N3 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 . N <br /> (N Permanent Closures x $90) <br /> 5. Plan Check Fee $30• Y M E N 4 <br /> EEI \/E <br /> Total Number of Tanks .ENVIRONMENTAL HEALTH Total Fee Due � B• D® <br /> PERMIT/SERVICES <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 /> 0 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & lst 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 /> 2-86 <br /> 14(9T �� <br />