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FEE WORKSHEET ( /� <br /> DBA �nc�F�L �AS A•,� � CC2�G �ornPAN�/ — /L14Cy '6�!/r�'EC i�TFz2 <br /> ADDRESS soZ E . G2AnsT ` ��� �2Acy� CA . q5 Y7l0 <br /> ;oSrR6-_,ET Timmy, <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. _151 <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) Q' <br /> _- 1456 x Tnt..l #LW Tar.4g <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 /> (# e' 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 ?Deo Gn <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 /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 D Eft q <br /> Total Number of Tanks 4 Total Fee uta <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />