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FEE ORKSHEET <br /> F E <br /> AD <br /> S <br /> x. 4 <br /> Op <br /> G <br /> 1• �1 Ll I4 1 �e 4/ Ga$ , Tr Ci j <br /> a Ext str ng; FaC r l�ty and Ist Jan IS <br /> b. Additfional Tank Additi�ini1a :'T n_ks <br /> 2; State Surcharge` (per tank) ( u with: Pt °tplattn, <br /> on °eo OM1 '' .a .nd nt ;of i rai��c�� <br /> 5t Tr` a <br /> 3, *Temporary Closure (per tank Underground storage Tank in which <br /> storage has ceased but where the corner/orator proposes to <br /> re-use `tank within 2 gears.: <br /> r Temporary closunes X: <br /> 4. P'e anent Closure (per tank lJrrderrop storage Tank in which <br /> **Age,,has ceased and where the ower perata ° .no in <br /> o re-using tank within next years. <br /> Permanent l Cl os r'es :x $90)-- <br /> -16t61 <br /> Q).Total Number of Tanks Total ree Due <br /> Dake a1 fees payable to San Joa Win local tat District. inclose this worhedt <br /> with your check and "the completed applictir�. <br /> APP[.E n»ua1 Fee for Facility �wih;4 Tanks: < <br /> a <br /> I regular, I unleaded, 1. supreme,. I waste 01'1 } <br /> 1a. Existing Facility &r1t Tank, 156 <br /> b.. 3 Additional Tank x '$5D 150 <br /> 2. Mate Surcharge# 4,,"T <br /> anks x '56 <br /> } <br /> Total Number, ofTa, rrk 4 Total Fee" Due 4 <br /> ; <br /> �E HEALT <br /> 1R E E <br /> rT SERVIC <br /> *Borth 'closures will be conditioned. :Contact a'`°Health District R res a r e <br /> 421851- <br /> ..P':+t <br />