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v � <br /> FEE WOW HEET <br /> DBA SS,�..�-^-/�G�� . <br /> ADDRESS / JJ /UG �/Y L/F 9so01 <br /> - <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) zoo <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) / <br /> -Tvtul N-. _. Ta-1,S)__.. _.__ _. _ _ _ <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 /> (#_ 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 /> (# Permanent Closures x $90) <br /> Total Number of Tanks <br /> y 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 /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 y I <br /> T0 <br /> otal Number of Tanks 4 Total Fee Q�V <br /> JAN 3 1 198b <br /> ENVIRUMV,4TAL HEALTH <br /> *Both closures will be conditioned. Contact a health District AV*V*M1PP5 <br /> 12/85 <br />