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FEE WORKSHEET PER EACH FACILITY , FACILITY <br /> 06A U„ !4� ADDRESS CP� wY <br /> MAILING ADDRESS S <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 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 /> (f_ 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 Qwner/operator has no intent <br /> of re-using tank , <br /> PAYMENT <br /> (F ?/ Permanent Closures x $90) RECEIVED <br /> 5. Plan Check Fee $30. OCT 19 1988 <br /> ENVIRONMENTAL HEALTH d°� <br /> Total Number of Tanks PERMIT/S%VkMSFee Due <br /> � � Uoo <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 8 1st Tank S1SO <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-126 <br /> 0G1 al <br />