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FEE WORKSHEET PER EACH FACILITO `` l7 <br /> DBA <br /> — / l �� ADDRESS Y //ZO bvAZZ5,0 � ack;emr <br /> MAILING ADDRESS SIA <br /> I. Operating Permit Application/Annual Inspection Fee <br /> �g7 <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (/ Additional Tanks x $50) S� <br /> 2. State Surcharge (per tank) (Due with Permit Application. 0164;, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total M 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 f3 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 /> c� . 2+� ra N•iL <br /> 5. Plan Check Fee $30. <br /> i <br /> Total Number of Tanks Total Fee Due <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 & 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 /> uc� � r <br />