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EE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> BA 1.� l EvS n�j�iJ� V-) iJC- ADDRESS ��— <br /> ILING ADDRESS <br /> Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N Additional Tanks x $50) <br /> State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit andtemporary closure) <br /> ($56 x Total M Tanks) <br /> • *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 03 to calculate surcharge) <br /> • "Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the gwner/operator has no intent <br /> of re-using tank. <br /> (M�Z Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks <br /> 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 S 1st Tank $150 <br /> b. 3 Additional Tanks x $50 ISO <br /> 2. State Surcharge, 4 Tanks x SS6 224 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-26 <br /> N01 f • • <br />