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( LL Nunr.�nLLI VLR LALH FACILI <br /> FACI L I TY <br /> i>BA • /j <br /> fa ADDRESS <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional. Tanks (M Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($.56 x Total 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 /> (#_ 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 /> (l �—?- Permanent Closures x $90) c <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks �((!� Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet �1 <br /> with your check . I j <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, I waste oil ) <br /> la. 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 $524 <br /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> 2-R6 <br /> UGC al <br />