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FEE WORKSHEET <br /> DBA )}1C.V-ITj00 t* VV ZCK-i L�4 . <br /> ADDRESS T 5'Cl1j ', CQ 917-Q t - <br /> /,u6sr X20 t4 I <br /> 3u6tT-�3�50. &Mouv s'f <br /> 1. Operating Permit Application/Annual Inspection Fee 6 <br /> a. Existing Facility and 1st Tank @ $150. 1, <br /> b. Additional Tanks (# 3 Additional Tanks x $50) 1� <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) 10 <br /> ($56 x Total # Tanks) <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 /> op <br /> Total Number of Tanks Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this workshee t <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (I 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 Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representat" 4 1986 <br /> ENVIROMENTAL HEALTH <br /> 12/85 FERMIT/SERVICES <br />