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/ 46' <br /> FEE WORJ(SHEET v", 00< <br /> O „( <br /> to <br /> DBA <br /> ADDRESS <br /> 4� <br /> 1. Operating Permit Ap cation/Annual Inspection Fee 4L <br /> p v 1 / <br /> a. Existing Facility and 1st Tank @ $150. .1 <br /> b. Additional Tanks (# Additional Tanks x $50) Q. <br /> 2. State Surcharge (per tank) (Due with Permit Application, � j <br /> on renewal or amendment of operation permit) d <br /> ($56 x Total # Tanks) "'t <br /> 3. "Temporary Closure (per. ia��r;) Undcr^�rou^d Storage Tank. in ,-hich <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 $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 /> %CF,-Aa\14 <br /> y <br /> *Both closures will be conditioned. Contact a Health District Represen ati,40'1 2 '! <br /> °i, <br /> ENVIROWi�EfvTAL HEALTH <br /> 12/85 FERMIT/SERVICES <br />