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FEE WORKSHEET PER EACH FACIA IY �. <br /> FACILITY <br /> DBA LttILE� S A/U/1 SEN/ .rNC . ADDRESS /q ��� N � 71-D. 604, <br /> MAI LING ADDRESS SPO �"� CX LC�� Cry` <br /> 1. New Facility or Addition <br /> T <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. TJN <br /> b. Additional Tanks (# � Additional Tanks x $50) 00 <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) -21L <br /> ($56 x Total # Tanks) <br /> 4. *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 Total Fee Due • 00 <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 /> *Both .'osures will be conditioned Contact a Health District Representative. <br /> 2-8f <br />