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do <br /> FEE WORKSHEET <br /> DBA <br /> ADDRESS <br /> lication/Annual Inspection Fee <br /> .v <br /> 1. Operating Permit App p _ <br /> a. Existing Facility and 1st Tank @ $150. ,,- <br /> Additional Tanks x $50) <br /> b, Additional Tanks (# Application, <br /> 2, State Surcharge (per tank) (Due with Permit App <br /> on renewal or amendment of operation permit) v ` <br /> 1y+J V x Total ll�_ <br /> ari�1 <br /> r tank) Underground Storage Tank in which <br /> 3, *Temporary Closure (pe <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. -$-- <br /> ( Temporary closures x $80) <br /> 4, *Permanent Closure (per tank) Underground StorageTank inwhich <br /> storage has ceased and where the owner/operator <br /> h <br /> as no intent <br /> of re-using tank within next 2 years. ` <br /> ( Permanent Closures x $90) <br /> �v <br /> Total Fee Due <br /> Total Number of Tanks <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 /> (l, regular, 1 unleaded, 1 supreme, 1 waste oil ` <br /> la. 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 $5 N 3 1 1986 <br /> ENVIROMENTA! HEALTH <br /> FERMiTAERYiCES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 5 � <br />