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�E WORKSHEET PER EACH FACILI4y <br /> FACILITY <br /> DBA ADDRESS f t . ., <br /> MAILING ADDRESS 5 G <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. �2t u <br /> T 1 <br /> b. Additional Tanks (N Additional Tanks x $50) �c -o <br /> 2. State Surcharge (per tank) (Due with Permit Application, EN 2- <br /> r- <br /> on renewal or amendment of operation permit and temporary closur`f�`-9r a <br /> ($56 x Total H Tanks) ��� Q <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which N <y <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (N_ Temporary closures x $80) (See above N3 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 , <br /> (N_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Totae u/D e <br /> ( sOWJ� kA- <br /> jL4 c .w7s- 't' kre"e. max_ .eL. <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 & 1st 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 /> *Both closures will be conditioned. Contact a Health District Representative <br />