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FEE WORKSHEET <br /> DBAA/ <br /> ADDRESS ^/', <br /> 4�7 00 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 5 U•� <br /> b. Additional Tanks (# 0 Additional Tanks x $50) %*PolL' V'F§ <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # Tanks) ----- —_ �/ <br /> e. ta----_ c, _ 1__. _ i ... d_L3 rani. <br /> a, iempot aiy Closure leper UdruC/ .}i ivci , riiu�d •.Iii-age iaiin lii viii Cii <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 Total Fee Due O` <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 $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 �k' <br />