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FEE WORKSHEET <br /> yc tiM,er L <br /> DBA OGlo �%ice <br /> �a <br /> ADDRESS / Af —Z <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 /> ($56x 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. vv.f � " y l l� �� .c �� <br /> C, <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. U Lq <br /> (# Permanent Closures x $90) Ao <br /> Total Number of Tanks Total Fee Due �d=' <br /> Make all fees pavable to San Joaquin Local Health District. Enclose this workSt <br /> -hnrV Anri tho rnrnplptar♦ Anel irptinn <br /> a <br /> h <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil) <br /> Ia. Existing Facility & ist 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 <br /> *Both closures will be conditioned.tContact a Health District Repres6ntative,, p ,4 <br /> 12/85 <br />