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FEE WORK-SHEET PER EACH FACILITY <br /> FACILITY <br /> ADDRESS r /9etrPc'�/ <br /> MAILING ADDRESS ' .0. 6 7,V,5R_&niA) <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (# _,_ Additional Tanks x $50) 166 <br /> -2. State Surcharge (per tank) (Due with Permit 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 /> ra-u,— tank within ? yearc . <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 /> of re-using tank , <br /> (# Permanent Closures x $90) PAYMENT <br /> RECEIVED <br /> Plan Check Fee $30. <br /> NOV 3198.E <br /> _ yl 0v <br /> ENVIRONMENT' <br /> Total Number of Tanks PERMT*frV�H Ab <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for` Faeility with 4 Tanks <br /> (1 regular, 1 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-H6 <br /> 1 9 <br /> 0 <br />