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FEE WORKSHLET PER EACH FACILITY <br /> FACILITY _ <br /> DBA 14y-Lo S�l� `��n ( )C"'.� ADDRESS �-�� <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank At Facility @ $150. <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 /> (I Temporary closures x $80) (See above N3 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 /> (per Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks <br /> � Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet �I -. <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 6 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 ..f. <br />