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FEE WORK -SHEET PER EACH FACILIf <br />,DBA _ )o • ^� .(�Arvo U �C2ic�f�`rjC,,i IST FACILITY <br />A�DDRESS //Oi/ <br />MAILING ADDRESS—����^e TJ ) %��7,9 <br />a <br />//kl V <br />1. 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 />($56 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 />(!f_ Temporary closures x $80) (See above M3 to calculate surcharge) <br />Q*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 />(k/ Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks / Total Fee Due <br />rc cla , Lq <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with your check. <br />L <br />J�nl �-aq o <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, I unleaded, 1 supreme, 1 waste oil)" <br />Ia. Existing Facility & 1st Tank $150 <br />b. 3 Additional Tanks x $50 150 PAE.NT <br />2. State Surcharge, 4 Tanks x $56 224 R E C E.LV F—D <br />s'G <br />Total Number of Tanks 4 Total Fee Due $524 1111M " bbW <br />ENVIRONMENTAL HEA <br />LTI <br />PERMII/SE&VJ.0 , <br />*Both closures will be conditioned. Contact a Health District Representative. <br />2-86 <br />0G7 'a I <br />