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r LL WUROULL I PER EACH FACI L I , <br /> --w <br /> FACILITY <br /> —DBA <br /> ADDRESS '/fCJ _ .. <br /> MAILING ADDRESS <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 /> (# 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 no intent <br /> of re-using tank . I <br /> (# , Permanent Closures x $90) <br /> S. Plan Check Fee $30. <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 PAYMENT <br /> ( 1 regular, i unleaded, 1 supreme, 1 waste oil ) RECEIVED <br /> Ia. Existing Facility & 1st Tank $150 SEP 14 1988 <br /> b. 3 Additional Tanks x $50 150 <br /> RONMENTAL HEALTH <br /> 2. State Surcharge, 4 Tanks x $56 224 ENVI PERMIT/SERVICES <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />