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FEE WORKSHEET {p� <br /> DBA <br /> ADDRESS �S <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @-$150. <br /> b. Additional Tanks (#�i Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) /� D <br /> ($56 x Total # 3 Tank) / 0 <br /> 3. *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 /> 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) Q <br /> ZlI <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 and the completed application. <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 save 2. State Surcharge, 4 Tanks x $56 I: ave <br /> Total Number of Tanks 4 Total Fee Due 52 <br /> EB 5 %b <br /> ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned Contact a Health District Reprelmwwwt$ <br /> 12/85 • <br /> • <br />