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FEE N RK-SHEET P EACH FACILITYO <br /> DBAFACILITY <br /> - 1�1���� IQ(1J ('S13 �cJ & �n ADDRESS <br /> MAILING ADDRESS FOX <br /> 1. 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 /> (S56 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 /3 to calculate surcharge) <br /> 4. *Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the gwner/operator has no intent <br /> of re-using tank , <br /> ei1'1 <br /> (N I Permanent Closures x $90) <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> PAYMENT <br /> with your check . RECEIVED <br /> DEC 2 0 1988 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ENVIRONMENTAL HEALTH <br /> ( 1 regular, 1 unleaded, 1 supreme. 1 waste oil ) PERMIT/SERVICES <br /> Ia. Existing Facility & 1st Tank 5150 <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-„G <br />