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�.. <br /> FEE WORKSHEET <br /> DBA �LAe-R40tN1a—A B1c LA <br /> ADDRESS T;l ii -��F �'C�� CQ 9SZ� <br /> 1 51-C(Zd WAZ-e- <br /> 3-u6sT-63S�SOQC//tA'� S-�'. <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# 3 Additional Tanks x $50) � <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # Tanks) � <br /> 3. *Temporary Closure (per tanks Underaround Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (#,AL-'>� 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 /> ofd <br /> Total Number of TanksTotal 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 /> I�b <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 Representat 4 1986 <br /> ENVIRUMENTAL HEALTH <br /> 12/85 FERMIT/SERVICES <br />