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FEE WORKSHEET �p <br />DBA /L�' �,f t// c�;W70zV <br />ADDRESS 30/ k/. <br />9s <br />1. <br />Operating Permit Application/Annual Inspection Fee <br />a. Existing Facility and 1st Tank @ $150. <br />b. Additional Tanks (#__3 Additional Tanks x $50) <br />Z5,0 <br />2. <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit) <br />(.-6 x Total # Tanks ) <br />ZZ <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 />(# Temporary closures x $80) <br />4. <br />*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 within next 2 years. <br />(# Permanent Closures x $90) <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 and the completed application. <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, 1 waste oil) <br />Ia. Existing Facility & 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />Total Fee Due <br />$150 <br />1 <br />2 <br />2 <br />$524 FEB. 2 8 1986 <br />ENVIROMENTAL HEALTH <br />FERMIT/SERVICES <br />*Both closures will be conditioned. Contact a Health District Representative. <br />12/85 <br />