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FEE WORKSHEET PER EACH FACILITY <br /> , ., FACILITY <br /> DBA ADDRESS :'5 -_3 <br /> MAILING !1 RE � <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (l_/ Additional Tanks x $50) SCS <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_L 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 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 /> (/ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks / Total Fee Due <br /> Cts <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 /> Ia. Existing Facility b 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 conditioned. Contact a Health District Representative_ <br /> 2 .a. <br />