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i <br /> v <br /> FEE WORKSHEET <br /> DBA (/C/IlJS �D �/Dy�C-Ss/Q-V l PiFJ <br /> ADDRESS. <br /> 1. New Facility or Addition — <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. , SO <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total #--L Tanks) <br /> 4. *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. y� <br /> (=_ Temporary closures x $80) (� <br /> 5. *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 <br /> Total Fee Due ^T <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 p Cr2a��0 <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) hy�b <br /> la. Existing Facility & 1st Tank $1 0 M 1j <br /> b. 3 Additional Tanks x $50 1&IROMENTAL TH <br /> 2. State Surcharge,_4 Tanks x $56 224FERMIT/ RVICES <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 1-86 0 f/ <br />