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KSHEETa _ <br /> ADDRESS <br /> CID <br /> 1, Operating Permit Application/Annual inspection Fee ,7Or <br /> Facility and 1st Tank @ $150. p <br /> a, Existing <br /> Additional Tanks x $50) <br /> b, Additional Tanks (#�--Due with Permit Application, <br /> 2. State Surcharge (per tank) ( p� <br /> on renewal or amendment of operation permit) <br /> ($56 x Total #�_ Tanks) <br /> *�;em^orary Closure (per tank) Underground Storage Tank in which <br /> +' owner/operator proposes to <br /> storage has ceased but where the <br /> re-use tank within 2 years. <br /> (# Temporary <br /> closures x $80) <br /> torage Tank in which4, *permanent Closure (per tank) Underground S <br /> storage has ceased and where the owner/operator has no intent <br /> next 2 years. <br /> tank within ned <br /> of re-using ----- <br /> (# Permanent Closures x $90) <br /> Total Fee Duel-- <br /> Total Number of Tanks _— <br /> a Zz <br /> able to San Joaquin Local Health District. Enclose this worksheet <br /> Make all fees p Y <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> oil )(1 regular, 1 unleaded, 1 supreme, 1 waste o $150 <br /> Ia. Existing Facility & 1st Tank <br /> 150 <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> Total Number of Tanks 4 <br /> Total FeeV,'$524 <br /> Aki , <br /> ' ENVERUM�'��,EAL <br /> 114 <br /> *Both closures will be conditioned. Contact a Health District Re�`_ _.- <br /> 12/85 0 <br />