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SAN JOAOUIN Environmental Health Department <br /> C- OUNT Y <br /> UNDERGROUND STORAGE TANK FEE WORKSHEET <br /> FACILITY NAME DATE <br /> FACILITY ADDRESS CITY _ STATE ZIP CODE <br /> gyp �•�/ ,mow- ,�i®n/ <br /> CA <br /> SERVICE REQUEST (CHOOSE ONE FEE SUBTOTAL <br /> Retrofit/Repair — Full Permit $456* <br /> Retrofit/Repair — Minor Plan Check $ 152* <br /> Tank Lining $456* per tank** lined <br /> Temporary Closure $456* <br /> Permanent Tank Closure - Removal $456* per tank** removed <br /> Permanent Tank Closure — Closure in Place $456* per tank** closed in place <br /> Tank Installation $3040* <br /> ADDITIONAL FEES FEE SUBTOTAL <br /> ' Failure to Obtain a Permit' Penalty $456 <br /> CERS Consultation $ 152* <br /> New Owner Consultation $ 152 <br /> ANNUAL CUPA OPERATING PERMITS FEE SUBTOTAL <br /> (FOR NEW INSTALLATIONS — ALL APPLY) (PAID PRIOR TO FINAL APPROVAL) <br /> Hazardous Waste Generator <5 tonslyr $249 (if Z5 tons/yr, varies) <br /> Hazardous Materials Business Plan (HMBP) Common $ 81 or Regular $279 <br /> HMBP Chemical Fee $ 17 per chemical <br /> Underground Storage Tank - Facility $ 1 , 582 ( installed July 2004 or later) <br /> Underground Storage Tank - Tank $250 per tank** <br /> State Facility Surcharge $49 <br /> State Tank Surcharge $20 per tank** <br /> CERS Processing Fee $ 30 <br /> UNREPORTED TANK FEES SUBTOTAL <br /> (ORIGINAL ANNUAL FEES, LISTED BELOW, WILL BE DOUBLED) <br /> 2016 $ 583 (facility) + $ 139 per tank** x2 <br /> 2017 $641 (facility) + $ 152 per tank** x2 <br /> 2018 $961 post-July 20x4 or $680 pr" uly 2004 (facility) + $228 per tank** x2 <br /> 2019 $ 961 post-Jury 2004 or $680 pre-July 2004 (facility) + $228 per tank** x2 <br /> 2020 $ 1582 post-July 2004 or $982 prewIuly 2004 (facility) + $250 per tank** x2 <br /> TOTAL AMOUNT DUE $ .y5 <br /> " FEES ARE BASED ON THE $162 HOURLY RATE . TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> ** EACH COMPARTMENT IN A SPLIT TANK IS COUNTED AS A SEPARATE TANK, <br /> REVISED 512412021 <br /> 1868 E . Hazelton Avenue ( Stockton , California 952051 T 209 468- 3420 ( F 209 464-0138 1 www. sjgov. org/elid <br /> i <br /> i <br /> s <br />€t <br /> E <br />