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FEE WORKSHEET PER EACH FACIL TY <br /> FACILITY o <br /> DBA �� <br /> , �j ��c� ?j ,r ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ 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 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 /> (# Permanent Closures x $90) <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 <br /> with your check. <br /> PAYMENT <br /> RECEIVED <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> JUN 131988 <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ER,41RONMENTAL HEALTH. <br /> la. Existing Facility 6 1st Tank $150 p_ERMITISWICES <br /> b. 3 Additional Tanks x $50 1S0 <br /> 2. State Surcharge, 4 Tanks x $56 224 �� <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *60th closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> UCS aI <br />