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FEE WORKS14EET PER EACH FACILITY • <br /> DBA FACILIT <br /> ADDRESS <br /> Y c <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (M 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 /> ($56x 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 /> (1_ 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 /> o/ re-using tank, <br /> (/_�_ Permanent Closures x $90) � <br /> 5. 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 /> with your check. <br /> p P.`f tA v gD <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks R g GE <br /> ( 1 regular, I unleaded, 1 supreme, I waste oil ) �Ov r 198 <br /> Ia. Existing Facility b 1st Tank $150 MENTP`NEP�TH <br /> b. 3 Additional Tanks x $50IM IRW SERVICES� <br /> 2. State Surcharge, 4 Tanks x $56 224 PER �1 L(L ` <br /> Total Number of Tanks 4 Total Fee Due $524 /r <br /> , <br />*Both closures will be conditioned. Contact a Health District Representative. <br /> 2 -aG <br />