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WORKSHEET PER EACH FACILITY <br /> FACILITY <br /> ADDRESS <br /> toclr';on, CE1 09205 <br /> (LING ADDRESS 4407 13 . 'Waterloo ! OL <br /> Stocl'';on, CIS ,2 <br /> Operating Permit Application/Annual Inspection Fee <br /> 150.00 <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (# 2 Additional Tanks x $50) inn nn <br /> c^.. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 3 Tanks) <br /> *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. Plan Check Fee $30. <br /> Total Number of Tanks 3 Total Fee Due 2z 1R -0 r1 <br /> A� <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 & 1st Tank $150 <br /> h. 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 />