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FEE WORKSHEET PER EACH FACIA.,—r / <br /> FACILITY <br /> DBA ADDRESS <br /> MAILING ADDRESS <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. <br /> b. Additional Tanks (#__/ / Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total #_Z �— 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 / ?-1 Total Fee Due ` <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 P <br /> ab. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> MAR 5 'lytib <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> ENVIROMENTAL HEALTH <br /> FERNUT/SERVICES <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 2-86 <br /> Vft.. <br />