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FEE WORKSHEET <br /> DBA _�l R AMC) --� -- <br /> ADDRESS cga2-3O AJ, C,Je-477- 4-AAl6 Ye7aw' I CA gS"•ZG <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# A Additional Tanks x $50) fc1� <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> 4 <br /> f <br /> ` n, renewal or amendment of operation permit) <br /> ($56 x Total # .3 Tanks) <br /> 3. *T-mpor-ry ('101—C inn- #-.nlil II-ndeP r/lY`nt1nd Stora., 7wnl< �n h�4h <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 /> (# Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due �� <br /> V <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet 1 <br /> with your check <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. 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 <br /> Total Fee 'Due $524 <br /> *Both closures will be conditioned. Contact a health District Representative. <br /> 12/85 <br />