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FEE WORK-SHEET OCR EACH FACILIT00FACILIT1 <br /> 06A j �� Ve n v e <br /> ADDRESS Y °5 L oG{ I Lodi,ofh t?q <br /> MAILING ADDRESS sarige- <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N 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 f 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 /> (0, Temporary closures x $80) (See above f3 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 , PAYMENT I <br /> (I Permanent Closures x 190) RECEIVED �x � 0 <br /> 5. Plan Check Fee 130. OCT 1 51987 <br /> A .ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <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 /> ( 1 regular, I unleaded, 1 supreme, i waste oil ) <br /> la. Existing Facility 6 1St Tank 5150 <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 /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2 0 <br />