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. M � <br /> FEE WORKSHEET <br /> DBA I��nIL(�N—�AI�IJJCE2IN�—���ti�Z /D� q1��� <br /> ADDRESS NIS &I--040)0W anc"�r <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 #___Z__ Tanks) <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 /> (#__L Permanent Closures x $90) 90 <br /> Total Number of Tanks QA{la Total Fee Due 9Q <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. <br />—W <br /> AMPLE - 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 ��Q <br /> 1� <br /> Total Number of Tanks 4 Total Fee Due $5Z1gN 3 1 1986 <br /> ENVIROMEIVTAL HEALTH <br /> FERMIT/SERVICES <br /> ih closures will be conditioned. Contact a Health District Representative. <br /> 85 <br />