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FEE WORKSHLET PER EACH FACIL <br /> 1� ` FACILITY "� o <br /> DBA ADDRESS LD L GCL° �2GGL <br /> MAIL ADDRESS �1),.2/ <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <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 /> ($56 x Total M 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 /> (B_ 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 PPA 4MIN T, <br /> of re-using tank . RECEIVED <br /> (#4Z Permanent Closures x $90) NOY 7 1986 <br /> 5. Plan Check Fee $30. ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> ;r <br /> Total Number of Tanks 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 /> ( I regular, I unleaded , 1 supreme, I 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 5524 <br /> *Doth closures_ wil-1 be- conditiuned. Contact a Health District Representative.- <br /> Z-86 <br /> UG-7 j <br />