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FEE WORK-SHEET PER EACH FACILITY <br /> /� FACILITY <br /> DBA ��a"-4 G rM f V ADDRESS <br /> HAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ 1150. <br /> b. Additional Tanks (/ 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 /> (156 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 /> (/. Temporary closures x 180) (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 intent <br /> of re-using tank . <br /> (/_ Permanent Closures x 190) <br /> 5. Plan Check Fee $30. r R <br /> Total Number of Tanks Total Fee Duel lU• <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 /> 6 1 <br /> ( I regular, 1 unleaded, l supreme, 1 waste oil ) <br /> la. Existing Facility b 1st Tank $150 QCT �N(P�CES��N <br /> b. 3 Additional Tanks x 150 150 FNJ\W0 M�OIpw \ , 4, <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 V <br /> *Both closures will be conditioned. Contact a Health District Representative. <br />