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FEE WORKSHEET UNITED <br /> DBA <br /> TRUCK & AUT® ®SMAMERS <br /> ADDRESS <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 <br /> on renewal or amendment of operation Permit Application, <br /> Permit) <br /> ($56 x Total # <br /> Tanks) <br /> 3. *Ternpor•ary Closure (per Lank) Undercround 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 /> (#-�L Permanent Closures x $90) <br /> Total Number of Tanks <br /> Total Fee Due <br /> lake all fees payable to San Joaquin Local Health District <br /> ith your check _ Enclose this worksheet <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank <br /> b. 3 Additional Tanks x $5015 <br /> 2. State Surcharge, 4 Tanks x $56 F441 4 Ift) vv1 <br /> Total Number of Tanks 4ENVIR MENTAL HEALTH <br /> — Total Fee Due F YSERVICES <br /> .h closures will be conditioned. Contact a Health District Re resentative. <br /> 35 <br />