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FEE WO�KSHEETr` <br /> r <br /> DBA Z111A E ,� s <br /> ADDRESS .712A11 .5- 11 1�0 -722 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150, (50,°O <br /> b. Additional Tanks (# Y Additional Tanks x $50) � <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) 04 <br /> (;`6 x To a1 # _ Tares) -- <br /> 3. *Temporary Closure (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 j Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 1waste oil ) <br /> Ia. Existing Facility & 1st Tank $160 <br /> b, 3 Additional Tanks x $50 150 <br /> 2, State Surcharge, 4 Tanks x $56 / 224 <br /> i <br /> Total Number of Tanks 4 Total Fee D 151&&aw + <br /> r <br /> FEB 5 1980 <br /> *Both closures will be conditioned. Contact a Health District k, e,en <br /> tative. <br /> PERMIT/SMIC AL IISETH <br /> 12/35 <br />