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WORK-SHEETWORK-SHEET PER EACH FACILITY <br />t : A <br />Make all fees payable to San Joaquin local Health District. Enclose this worksheet <br />with your check. �C-- Cy— <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, l supreme, 1 waste oil) <br />la. Existing Facility S 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 <br />Total Fee Due $524 <br />*Both closures will be conditioned. Contact a Health District Representative. <br />UST IQl <br />7 <br />1. <br />Operating Permit plication/Annual Inspection Fee <br />e <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (0 Additional Tanks x $50) <br />2. <br />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. <br />`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 />U Temporary closures x $80) (See above !3 to calculate surcharge) <br />-------- <br />4. <br />Permanent Closure (per tank) Underground Storage Tank in which <br />storage has ceased and where the gwner/operator has no intent <br />of re -using tank. PAYMENT <br />(# Permanent Closures x $90) RECEIVED <br />5. <br />Plan Check Fee $30. DEC 7 1988 <br />-� <br />_ VIR®NMENTAt N`' • " <br />TISER,. <br />P- <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. �C-- Cy— <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, l supreme, 1 waste oil) <br />la. Existing Facility S 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 <br />Total Fee Due $524 <br />*Both closures will be conditioned. Contact a Health District Representative. <br />UST IQl <br />