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FEE WORKSHEET <br /> DBAGt�lvt PAiu� pie ww --rl p 5,JaJ <br /> ADDRESS ) 502 5yae!t CA- 9saa4 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. ( � <br /> b. Additional Tanks (# -,2, 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) i bL <br /> 3. *Temporary Clusure (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 /> Total Number of Tanks 3 Total Fee Due 4) 8 <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 `y �� <br /> b. 3 Additional Tanks x $50 50F <br /> 2. State Surcharge, 4 Tanks x $56 224 E8 2 5 IY86 <br /> ENVIROMENTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $TMMIT/S£RVICtS <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />