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SAN 10 A Q U I N Environmental Health Department <br /> - - COU NTY-- -- <br /> UNDERGROUND STORAGE TANK FEE WORKSHEET <br /> FACILITY NAME DATE <br /> FACILITY ADDRESS CITY STATE ZIP CODE <br /> Ftp OP ly SA&q ICA QS3 7 7 <br /> SERVICE REQUEST (CHOOSE ONE) FEE SUBTOTAL <br /> Retrofit/Repair — Full Permit $456* <br /> Retrofit/Repair — Minor Plan Check $ 152* <br /> Tank Lining $456* per tank** lined <br /> Temporary Closure $456* <br /> Permanent Tank Closure - Removal $456* per tank** removed <br /> Permanent Tank Closure — Closure in Place $456* per tank** closed in place <br /> Tank Installation $3040* <br /> ADDITIONAL FEES FEE SUBTOTAL <br /> ' Failure to Obtain a Permit' Penalty $456 <br /> CERS Consultation $ 152* <br /> New Owner Consultation $ 152 <br /> ANNUAL CUPA OPERATING PERMITS FEE SUBTOTAL <br /> (FOR NEW INSTALLATIONS — ALL APPLY) (PAID PRIOR TO FINAL APPROVAL) <br /> Hazardous Waste Generator <5 tons/yr $249 (If 2t5 tons/yr, varies) <br /> Hazardous Materials Business Plan ( HMBP) Common $81 or Regular $279 <br /> HMBP Chemical Fee $ 17 per chemical <br /> Underground Storage Tank - Facility $ 1 ,582 (installed July 20D4 or later) <br /> Underground Storage Tank - Tank $250 per tank** <br /> State Facility Surcharge $49 <br /> State Tank Surcharge $20 per tank** <br /> CERS Processing Fee $30 <br /> UNREPORTED TANK FEES SUBTOTAL <br /> (ORIGINAL ANNUAL FEES, LISTED BELOW, WILL BE DOUBLED) <br /> 2016 $583 (faculty) + $ 139 per tank** <br /> x2 <br /> 2017 $641 (facility) + $ 152 per tank** x2 <br /> 2018 $961 post-July 2004 or $680 pre-July 2004 (facility) + $228 per tank** x2 <br /> 2019 $961 post-July 2004 or $680 pre.July 2004 (facility) + $228 per tank** x2 <br /> 2020 $ 1582 post-July 2004 or $ 982 pr"uly 2004 (facility) + $250 per tank** x2 <br /> TOTAL AMOUNT DUE $ <br /> * FEES ARE BASED ON THE $ 152 HOURLY RATE. TIME THAT EXCEEDS FEES PAID WILL BE BILLED TO APPLICANT. <br /> ** EACH COMPARTMENT IN A SPLIT TANK 15 COUNTED AS A SEPARATE TANK . <br /> REVISED 511412021 <br /> 1868 E . Hazelton Avenue 1 Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www .sjgov.org/ehd <br />