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i <br /> FEE WORKSHEET PER EACH FACILITY <br /> FACILITY �� �.7 UJ�.✓�,,� <br /> DBAG, ADDRESS <br /> MAILING ADDRESS <br /> I. New Facility or Addition <br /> a. First Tank $150. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2, Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 1 Tanks) _ <br /> 4, *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 /> 5. *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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due _ <br /> A_ 3 Q <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet 36' c � <br /> with your check, <br /> QVf3�� <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 /> 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 condi ed. Contact a Health District resentative. <br />