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FEE WORKSHEET <br /> DBA <br /> h�� <br /> ADDRESS <br /> . I. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150, L� <br /> b. Additional Tanks # <br /> —f. Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with - <br /> Permit Application, <br /> on renewal or amendment of operation permit) <br /> �a <br /> SV x TctUl R -- T....,I.._1 1 ,1�' <br /> IgIIA�� <br /> 3. *Temporary Closure (per tank) Underground Storage Tank in which V <br /> storage has ceased but where the owner/operator proposes to <br /> reuse 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 <br /> _— Total Fee Due <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. <br /> EXAMPLE_ - Annual Fee for Facility with 4 Tanks <br /> (I regular, 1 unleaded, I supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 <br /> 2• State Surcharge, 4 Tanks x $56 <br /> Total Number of Tanks 4 Total Fee Due $524flAP Ib <br /> l NVIRt7ME.-NTAL HEALTH <br /> E ERMIT/S€RVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br /> i <br />