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law ,0000, <br /> FEE WORKSHEET <br /> DBA .4�1—G!/`G'-r <br /> ADDRESSy/�-ti s< < e"t ls< T�uy ✓fib c Cc s Cf 9 ZEoB <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. /SO <br /> b. Additional Tanks (# 0— Additional Tanks x $50) z o 0 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Tota' # 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 /> O � <br /> Total Number of Tanks -S Total Fee Due 6 3 t7 <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 $56 224 <br /> Total Number of Tanks 4 Total Fee DueV <br /> MAR 5 I5Ido <br /> *Both closures will be conditioned. Contact a Health District ReprMt#Ajb,RT„L HEALTH <br /> FERMIT/SERVICES <br /> 12/85 <br /> `. e/ <br />