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FEE WORKSHLET PER EACH FACILI <br /> 4A I ' <br /> OBA DRESS �D / <br /> MAILING ADDRES <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (l 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 I3 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 integtA Y M E N T <br /> of re-using tank _ RECEIVED <br /> (d Permanent Closures x $90) FEB 2 i )9ai; 2 7L- <br /> 5. Plan Check Fee $30. ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Total Number of Tanks Total Fee Due -L <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 & 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 /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> 2-aG <br /> ueT ':� r <br />