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FEE WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> ADDRESS <br /> DBA <br /> MAILING ADD RESSCb I � `��� LQI '`!\ <br /> �j72Z�11 <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 Surcharqe (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 /> (I 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 gwner/operator has no intent <br /> of re-using tank . <br /> ( r Permanent Closures x $90) PAYMENT <br /> 5. 'Plan Check Fee $30. RECEIVED <br /> OCT 191988 <br /> ENVIRONMENTALHfWIH <br /> Total dumber of Tanks Fee Due <br /> PERMIT jSERVICES <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 /> Ia. Existing Facility b Ist 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 $524 <br /> *Goth closures will be conditioned. Contact a Health District Representative. <br /> 2-;;6 & <br /> OTT- f <br />