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FEE WORKSHEET /� <br /> DBA �ac F c �AS aaN� �4Lr2 c rC: V 9P <br /> ADDRESS glS'75 J1Cr0R 20 A-0 V k=T "P- w CA 95253 <br /> /yjy,.ci.JG ; /� W .�-v� sT U.eroe Cry, 9s-a�s3 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150 <br /> b. Additional Tanks (# 4)— Additional Tanks x $50) ®� <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) 5� <br /> ($56 x Total #_L 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. <br /> (#_19- Permanent Closures x $90) <br /> Total Number of Tanks 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 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 <br /> Total Number of Tanks 4 Total Fee Due <br /> ENVIROMENTAL HEALTH <br /> F ERMIT/SERVICES <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 12/85 <br />