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FEE WORKSHEET <br /> DBA �sl�Ci fCOC,s' /y�/J✓J� � r/9Z T// zl��2& <br /> ADDRESS XE to <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and lst Tank @ $150. <br /> b. Additional Tanks ( Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on rano.,al or amend—ent of operationl <br /> ($56 x Total # Tanks) a� <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 /> t <br /> Total Number of Tanks f "'r Total Fee Due a G <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. " „ cJ Z Z7 <br /> -7 ` <br /> FOR <br /> EXAMPLE - Annual Fee for Facility with 4 Tank p ( p AY E <br /> (1 regular, 1 unleaded, l supreme, ste oil ) <br /> Ia. Existing Facility & 1st Tank FEB 14 $150 <br /> b. 3 'Additional Tanks x $50ENVIROMENTAL HEAL1HO 13 <br /> 2. State Surcharge, 4 Tanks x $56 FERMIT/SERVICES 224 <br /> X-JAN 15 f9$8 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> IL <br /> *Both closures will be conditioned. Contact a Health District Representative._ <br /> 12/85 <br />