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FEE WORKSHEET PER EACH FACILI <br /> DBA U L,'-,-- (D; 1 �� ,,,. FACILITY <br /> �`� � ADDRESS <br /> �17� <br /> MAILING ADDRESS ��� � G 713 <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2• State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 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 #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, Pian Check Fee $30. ✓ <br /> Total Number of Tanks Tott tW ue 3a•�� <br /> Make all fees IY\ <br /> rksheet <br /> payable to San Joa uin Local Health District. ��;rl�lose t �S,tiR�o <br /> with your check . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, 1 supreme, I waste oil ) <br /> la. 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 /> 2-86 <br /> f/'C,-T r� <br />