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FEE WORKSHEET ClBA _ G o l� & N4841 zr�- <br /> ADDRESSTOAJ�_ 1 ._ yLD 3 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. �J <br /> b. Additional Tanks (#_A?,o_ Additional Tanks x $50) fQ D <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($�6 x Total # _ Tanks) 6� <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 /> (#- Permanent Closures x $90) ZO <br /> Total Number of Tanks Total Fee Due '�"l <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 (� <br /> b. 3 Additional Tanks x $50 150 ����'+� r1 <br /> 2. State Surcharge, 4 Tanks x $56 224 FEB 2 8 1986 V <br /> Total Number of Tanks 4 Total Fee Due $524 ENVIROMENTAL HEALTH <br /> FERMITAERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />