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i <br />FEE WORKSHEET <br />9 <br />DBA -IVPeIZ. e , l 1ja7 <br />ADDRESS_r <br />1. <br />Operating Permit Application/Annual Inspection Fee <br />a. Existing Facility and 1st Tank @ $150. <br />X57' <br />b. Additional Tanks (# _3 Additional Tanks x $50) <br />�� <br />��0 <br />2. <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit) <br />($56 x Total # Tanks) <br />°2�y�� <br />3. <br />*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. <br />*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 <br />Make all fees payable to San Joaquin Local Health District. <br />with your check <br />Total Fee DueQK1ey <br />Enclose this worksheet)� <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 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />224 <br />Total Fee Du <br />MAR 5 <br />*Both closures will be conditioned. Contact a -- *e 1 th District ftMP&A1fl A . 4- ALTH <br />PERMIT/SERVICES <br />12/85 <br />