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-610 <br /> FEE WORKSHEET Ce- <br /> DBA <br /> o DBA <br /> ADDRESS .23 3 a 9 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# 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 C4esure (per-tank-) -Hndernround-S#.nrage Tank in-wMch- _ ---- - - - <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 <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 $1 <br /> b. 3 Additional Tanks x $50 1 �c�U�Y (� <br /> 2. State Surcharge, 4 Tanks x $56 2 <br /> _ — —JAN 2 lybb <br /> - <br /> Total Number of Tanks 4 Total Fee Due $4AyiROmENTAL HEALTH <br /> PEWT/MMCEB <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 12/85 / <br />