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FEE WORKSHEET <br /> DBA P F "T I-J r o <br /> ADDRESS �a �rS,, ���S �� ��� �- �' �� � '7 <br /> 1. Operating Permit Application/Annual Inspection Fee q� <br /> a. Existing Facility and 1st Tank @ $150. tU 15 oc <br /> b. Additional Tanks (# C' Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) ��yy <br /> ($55 x Total # / Tanks) <br /> �P �v <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 Ong 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 /> 1a. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 µ , 524 L. <br /> Total Number of Tanks 4 Total �ee Due $524 <br /> k* )JIJ <br /> ENVkkUME.NIAL HEALTH <br /> *Both closures will be conditioned. Contact a Health DistriEP WW� FSW ive. <br /> 12/85 9 <br />