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FEE WORKSHEET <br /> DBA <br /> ADDRESS / / <br /> l. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks ( Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a . Existing Facility and 1st Tank @ $150, �fl <br /> b. Additional Tanks (# X2 Additional Tanks x $50) <br /> State Surcharge (per tank) (Due with Permit Application, <br /> or renewal or amendment of operation permit} r <br /> (S56 x Total Tanks) <br /> 4. *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 /> 5. *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 /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, I 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 /> ;NjW:- <br /> T t :� � <br /> o a1 Number of Tanks 4 T F <br /> Total Fee Due $52 �� . <br /> APR n `98b <br /> EN11 WGENITAL HEALTH <br /> *Both closures will be conditioned. Contact a Health District Representatt.)MAIT/SERVICES <br /> 1-86 <br />