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7es� �*V-A D YraCOv F!L ^ gq <br /> FEE WORKSHEET S - — <br /> DBA W Vv% ii Sernit2 �h/G 1 <br /> ADDRESS �j5100 S . Lr7ghwky 33 Vernalis Cdji'� x$ 361/ <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) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # Tanks) <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. of <br /> (# 3 Permanent Closures x $90) 2-70 <br /> Total Number of Tanks 3 Total Fee Due 2,7.90—" <br /> /Z1sI187 <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 li 'fVl1 <br /> 2. State Surcharge, 4 Tanks x $56 224 MAR1986 <br /> Total Number of Tanks 4 Total Fee Due $524 ENVIRO ENT HEALTH <br /> r MIT/SEOVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />