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0 <br /> FEE WORKSHEET ii <br /> DBA a,�eic �,e�r� S >v e- <br /> -5i <br /> SI.�e r (� <br /> ADDRESS 2905`3 uta IUae_ At/ILA ur Avgl aL 4= , Cc'l �t <br /> ko Lr vkclew•avA - 9t(m- 4>�4- 3SCo w.e�� <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 /> ($56 x Total # Tanks) <br /> ' �rT., t-, kpe.,, s_ I,\ Ilr rin v.n.�..�. ,� c+..v.> T. n <br /> J, IC(I II�./Vlary LIUJUrC \ JCI l,a nk '-�ndc round ,� o c ank �n wh iijj <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 /> (# (o Permanent Closures x $90) 64 0 <br /> Total Number of Tanks Co Total Fee Duea <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, 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 $56 224 <br /> Total Number of Tanks -4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />