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FEE WORKSHEET / <br /> DBA L �"2 6e' <br /> ADDRESS /lo S � <br /> 1. New Facility or Addition �/5 <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) n `� <br /> 2. Operating Permit Application/Annual Inspection Fee G <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> (S56 x Total 4 Tanks) <br /> x. *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 /> 5. *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. <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 <br /> PFEB <br /> Total Number of Tanks 4 Total Fee Due 3 iauo <br /> ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned Contact a Health District Reprp)yICES <br /> 1-86 Nft ' <br />