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ES(#, M T,NjrjFT) Bit!; GARA,;F <br /> FEE WORKSHEET PER EACH FACILITY FACILITY 1176 stanislaus Street <br /> DBA ADDRESS Escalon, Ca. 95320 <br /> 1L niSTRICT, 1520 Yosemite Ave., Fscalon, Ca. 95320 <br /> MAILING ADDRESS FSCIILGr; <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150'00 <br /> b. Additional Tanks (#__2 - Additional Tanks x $50) 100000 <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 3 Tanks) 168.00 <br /> 4. *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 /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks <br /> 3 Total Pee Due 418.00 <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, l unleaded, 1 supreme, 1 waste oil ) aw <br /> z <br /> la. Existing Facility & 1st Tank $15 <br /> b. 3 Additional Tanks x $50 15 MAR 2 5 ISdo <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> "—`-IVIROMENTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $524 FERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />