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fLt. WORKSHLET PER EACH fACIL1T <br /> FACILITY <br /> DBA ( ( ADDRESS <br /> IL1NG ADDRESS �o0 - v ' GU�ujz <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (I Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Applications <br /> on renewal or amendment of operation permit and temporary closure) <br /> (156 x Total I 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 03 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, O� <br /> (/ Permanent Closures x $90) I <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due <br /> 9 <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 /> la. Existing Facility 6 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 /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2 -86 <br />