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1, y <br /> FEE WORKSHEET <br /> —j-, J011 CoT1S9�H$ <br /> DBA 2828nMIno808a <br /> Davis. <br /> ADDRESS Goc4--"�Fv.40 <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 /> ($56 x Total # Tanks) <br /> 7. *Temporary f1 v:urc \p%r +unk) Indergrcund Storage T .n,nk in <br /> .+ .C.. <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 worksheetq <br /> with your check 4 <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 �1 <br /> 2. State Surcharge, 4 Tanks x 224 <br /> C E MY <br /> OT54Tot 1 Number of Tanks 4 piTotal Fee <br /> b J eb <br /> F E 8 14 '19bb v N) <br /> EIVVtROMENTAl HEALTH N <br /> *Both closures will be conditioned. Contact a HebERMIISERWOESepresentative. <br /> 12/85 <br />