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NO. <br /> FEE WORKSHEET 'N <br /> e DBA �!/CHCS /I— �EiPI//CC- <br /> ADDRESS -�2 .310 O E4 E T '11 '4CL/, l9 . 9•S3 7e/, <br /> 1. Operating Permit Application/Annual Inspection Fee y <br /> a. Existing Facility and 1st Tank @ $150. �✓� �� <br /> b. Additional Tanks (# 3 Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <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) <br /> �O <br /> Total Number of Tanks Total Fee Due S� <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, i unleaded, 1 &uRrteme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 rti ;a <br /> ge$W52 <br /> Total Number of Tanks 4 Total Fee e $524 <br /> MAR 5 <br /> ENVIROMENTAL H&-LIH <br /> *Both closures will be conditioned. Contact a Health District <br /> 12/85 <br />