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J <br /> FEE WORKSHEE1 PER EACH FACILITY <br /> E FACILITY <br /> 0BA ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First'Tank at Facility @ $150, a <br /> b. Additional Tanks (N — 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 /> (/ 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 Wtent <br /> of re-using tank . <br /> (N Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Fee Due <br /> Total Number of Tanks <br /> pa <br /> Make all fees able to San Joaquin Local Health District. Enclose this worksheet <br /> � Y � <br /> with your check. <br /> �G <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular. 1 unleaded, l supreme. 1 waste oil ) $150 <br /> Ia. Existing Facility & 1st Tank <br /> 150 , <br /> b, 3 Additional Tanks x $50 � <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_ tical th District Representative. <br /> 2-11,6 <br />