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FEE WORKSHEET <br /> DBA //cJUf/' 7 <br /> v <br /> ADDRESS 37®© <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 /> ($55 x Total # Tanks) <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) <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. I [�MEa <br /> FEB 7 ++�a�I 6 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> EP1ViROMENTAL HEALTH <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) PERMIT/SERVICES <br /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 / /��Q t, f <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 a�; - 23 <br /> *Both closures will be conditioned Contact a Health District Representative <br /> 12/85 <br /> 42/IOC - c.v /S O ��il.os �'�i✓ o�m /�/u D p <br /> Z e6'A. /YA tit �'�we ., ., n > .,�'�v. _ _ �� i �14/'f'�as• <br />