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FEE WORKSHEET <br /> DBA <br /> ADDRESS <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 # T=nks) <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 it 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 ---A-- <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 " EUDEpR& ASSOCIATES <br /> (1 regu K -EIN * MATFRIALSTFST1NG <br /> yFOTONQ <br /> S l50 <br /> la. Ex- LAND AN()WATER"'SOURCE <br /> b. 3 �e 15f� <br /> PON HUNZEN, C.E. <br /> 2. .ata ENGINFERING MANAGER 224 <br /> Total Nur, $524 1]jI� <br /> 2825 EAST MYRTLE STREET $Tfl-13A5 N,CA 45205 L <br /> TELEPHONE 12095948-}345 Bei <br /> i <br /> PIT <br /> JAI <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> ENVIR0:Wr-.NTAL HEALTH <br /> FERMI T/SERVICES <br /> 12/85 <br />