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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> DIA ' ADDRE�/SS'S�/ <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N�_ Additional Tanks x $50) _ 56 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56x Total N 2 Tanks) 11-2 <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to 3 2 <br /> re-use tank within 2 years. <br /> (N_ 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 /> (q .2— Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Duel <br /> Make all fees payable to San Joaquin Local Health District. Enclose phA"4tM1ret <br /> with your check. RECEIVED <br /> FEB 271981 <br /> EXAMPLE - Annual Fee for FacilityTanks ENVIRONMENTAL HEALTH <br /> with 4 PERMIT/SERVICES <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) C K'S <br /> Ia. Existing Facility & 1st Tank $150 S y <br /> b. 3 Additional Tanks x $50 150 ; <br /> 2. State Surcharge, 4 Tanks x $56 224 ' ( -7/ 1 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-„G <br /> nnT 1 <br />