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�EE:WORKSHEET <br /> IBA j TX7h(1 GJ tt (b �A<��S �N L <br /> ,DDRESSS (� TUR�vPi -� �tSZ�k'T�r� cIS � , <br /> a <br /> Operating Permit Application/Annual Inspection Fee t <br /> a. Existing Facility and 1st Tank @ $150. %5b <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> r:tr% <br /> State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) co <br /> r <br /> ($56 x Total #� Tanks.)--- <br /> !. *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) J <br /> *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 /> f <br /> Total Number of Tanks Total Fee Due Zb� <br /> lake all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> t;, h your check and the completed application. <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 /> kBoth closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />