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FEE WORKSHEET <br /> DBA v Q L IAC T d L G �`r /C./'+� �' 1�✓ <br /> ADDRESS ©. �s 6 I o�t3 �S.S C J' -Crt /`/? I-1r` -d- <br /> 2,2 <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 /> ($5b x Total # Tanks) - <br /> *Temnnr.�ry rinc,ira (nar tanlrl Ilndprcirr_iinei Sfnrana TAnl in wki k <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 dumber of Tanks 1 Total Fee DueWw <br /> �1 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check <br /> EXAMPLE Annual Fee for Facility with 4 Tanks MAR 3 1 1986 <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) ENVIROM ENTAL HEALTH <br /> 1a. Existing Facility & 1st Tank $150 FERMIT/SERVICES <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due <br /> sawu, <br /> *Both closures will be conditioned. Contact a health District Repne Rb yeWAL HEALTH <br /> FERMIT/SERVICES <br /> 12/85 <br />