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.FEE WORKSHEET <br /> DBA <br /> ADDRESS pnd o Cemeterg Lane - Stne'rton <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. « 75[1 <br /> b. Additional Tanks (# u Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or ame�dmentIof operation permit) <br /> ($56x Total # 'WTanim) 5r+ <br /> 1.. *TamM ra ry Closure LYar_ +anL\ Ilnrlp rn_rniinrl Cf ncann. Tan.(L_i+}.. '.0 - <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (# 0 Temporary closures x $80) <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 within next 2 years. <br /> (#, o- Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due ,206 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check Q>- <br /> Y13 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 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 Dto <br /> JAN 2 !1 <br /> *Both closures will be conditioned. Contact a Health District HMm <br /> cc <br /> 12/85 <br />