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FEE WORK-SHEET <br /> PER <br /> - EAACH FACIL' <br /> 08A FACILITY <br /> w7.� �s/.�oDRESS ��� �T, f7 1�r2a Z <br /> MAILING ADDRESS lani <br /> I. Operating Permit Application/Annual Inspection Fee P <br /> a. First Tank at Facility @ $150. / p 312— <br /> b. <br /> / Z— <br /> b. Additional Tanks (N 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) lq 70 (�5 <br /> ($56 x Total N Tanks) '//qOo .�?-oC) <br /> 3. "Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to PAYMENT' <br /> re-use tank within 2 years. RECEIVED <br /> Temporary closures x $80) (See above f3 to calculate surcharge) ` <br /> 4. 'Permanent Closure (per tank) Underground Storage Tank in which ENVIRONMENTAL HEALTH <br /> storage has ceased and where the owner/operator has no intent PERMITJSERVICES <br /> of re-using tank . <br /> (N-2-Pernanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due <br /> 7 co <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet / < 6.. <br /> 74-Y7.4-z- 12uc <br /> with your check, � <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular. 1 unleaded, 1 supreme. I 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 /> *Both closures will be conditioned. Contact a Health District R� entative. <br /> 2-26 <br /> UGC at <br />