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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY Z6Y6 <br /> V S ADDRESS <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee P Ay M Lr PIT <br /> a. First Tank at Facilitv @ $150. RECEIVED <br /> b. Additional Tanks (/ Additional Tanks x $50) J U L 1111,988 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporaryNVIRONMENTAL HEALTH <br /> 4Ip"TOERVICES <br /> ($56 x Total A 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 /> (B_ Temporary closures 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 , <br /> (+y--L Permanent Closures x E90) 0 <br /> 5. Plan Check Fee $30. <br /> d ya of <br /> Total Number of Tanks � � Total Fee Due <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, I unleaded, l supreme, 1 waste oil ) <br /> Ia. Existing Facility 8 1st Tank 5150 /D <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 /> 2-80 <br />