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0 <br /> FEE WORKSHEET <br /> DBA <br /> ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (#__j 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 #__L_ lanks) <br /> 3. ellpJCfy LIUSUY'e r �clC' Undercir u id c <br /> 4 "ale T�rk il v11Ciikp ) vu .. at1 <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 Due12�0 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check <br /> Q� <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks � <br /> U j+ <br /> (1 regular, 1 Unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & lst Tank $150 <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge,-4 Tanks x $56 (9V <br /> —0 <br /> Total Number of Tanks 4 Total Fee Due $52F E B 9 t�dp <br /> ENVIROMEfVTA1 <br /> FERMIT/SERV1c�rH <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> - <br /> 12/85 <br /> s <br />