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FEE WORKSHEET PER EACM FACILITY T .. <br /> P27Z)_W.S�4AXj <br /> fACiLiTYOBA ADDRESS �' "� ' �'LaG -'►"' <br /> MAILING ADDRESS <br /> I. Operating Pemit Application Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (r 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 # 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 /> 0 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 gwner/operator has no intent <br /> of re-using tank, <br /> Permanent Closures x $90} PAYMENT <br /> f <br /> ( _L_. RECEIVE-� <br /> S. Plan Check Fee $30. DEC 7 <br /> Total Number of Tanks PERM IRIVi� Due 900 <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 /> 1a. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x E56 224 <br /> Total Number of Tanks 4 Total Fee Due 5524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-:10 <br />