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FEE WOWSHEET PER EACH FACILSe `J <br /> FACILITY Swti2.�vn Pik 4'V4 ��� <br /> DBA i-ry oR S7-ocx.T2,61 ADDRESS amen L::�r" <br /> MAILING ADDRESS Ci-rV /-TGG.. 312 SrccfcTorJ, Cs} 9S2o? - <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. �So <br /> b. Additional Tanks (# / Additional Tanks x $50) SD <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56x Total # 2 Tanks) 112- <br /> 4. <br /> 1Z4. *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 #3 to calculate surcharge) <br /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks 2 Total Fee Due 3i 2 <br /> M,ke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> th your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank <br /> b. 3 Additional Tanks x $50MAR 2 8 jydb <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> �ENVWMENTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $524FERMIT/SERVICES <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 2-86 <br />