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FEE WORKSHEET PERACH FACILIT <br /> 0 s 9 001)y VdNelr FACILITY <br /> DBA At-FRCOCG ALUA(ZA-00 ADDRESS IaloO L 17QFhtonji &-r<(- <br /> MAILING ADDRESS_ oS/ t �qdQ cQ-1 '7 -01`13 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (M 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 /> (N_ Temporary closures x $80) (See above #3 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 intenttPAYMENT <br /> of re-using tank . RECEIVED <br /> (NI Permanent Closures x $90) �{v J <br /> DEC 1986 <br /> 5. Plan Check Fee $30. <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> Total Number of Tanks / Total Fee Due D°' <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet S� <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 $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 /> 2-80 <br /> UC-7 � ( <br />