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FEE WORKSHCET PER <br /> EACH FACILITY/ FACILITY 1 <br /> DBA 7 ,� �Y�� /0 ADDRESS /C L-U( <br /> MAILING ADDRESS <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 /> ($56 x Total N 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 /> (I_ Temporary closures x $80) (See above l3 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 /> (f Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due C� <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 R E YM EN T <br /> ( 1 regular, 1 unleaded, 1 supreme, 1 waste oil ) CEIVEp <br /> Ia. Existing Facility 6 1st Tank $150 �(l(_ 2Q 19�� <br /> b. 3 Additional Tanks x $50 150ENv/R0A,, <br /> 2. State Surcharge, 4 Tanks x E56 224 PERMWsERvl ESkTy <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2 -NG <br />