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F <br /> FEE WORKSHEET PER EACH FACILITY 416 <br /> FACILITY <br /> DBA ri '� <-le" ADDRESS C) cit �* /terrJ <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (0- 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 /> ('S56 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 /> Ih (0 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 . <br /> ( Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Dumber of Tanks <br /> Total Fee Due q_p <br /> Make all fees payable to San Joaquin Local 'Health District. Enclose this worksheet <br /> PAYMENT <br /> with your check . RECEIVED <br /> JUL l 1987 <br /> EXAMPLE - Annual Fee for facility with 4 Tanks ENVIRONMENTAL HEALTH <br /> ( I regular, I unleaded, I supreme, I waste oil ) PERMITISEWICES <br /> Ia. Existing Facility & Ist Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x 556 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2 -,:G 0 q <br />