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FEE WORKSHEET PER EACH FACILITY — <br /> �( �i / FACILITY <br /> 08A <br /> —�"( Q�(17C���Y1I ADDRESS <br /> � Eztrei'�CL Xy// <br /> MAILING ADDRESS /(� Sl� � C /CQ�• �D�� ( �3/� <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. f5� <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, l <br /> on renewal or amendment of operation permit and temporary closure) <br /> (556 x Total I 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 /> (I_ Temporary closures x $80) (See above 03 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 /> (1 Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks / Total Fee Due 9l0 <br /> to <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 /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility b 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-R6 s — <br />