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� J <br /> FEE WORKSHEET <br /> DBA fI T / e /�e 7y QA/YC7 <br /> ADDRESS % 7 7 F C Ab J/n P <br /> Oje. 9126 6x 61�filj GZ S Loo /q/Z6 ' TiVoez cej <br /> a -7-7J -V10Ed 7,4C-7-0ZS <br /> -EJ-�1. Operating Permit a fn/Annus 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 /> TVta�- #-_ - 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 /> (#_ Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due <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 Tarks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks -4 Total Fee Due $524 `7 " <br /> / JAN 1 X986 <br /> *Both closures will be conditioned. Contact a Health District Representatj�WjROMEIvTAL HEALTH <br /> FERMIT/SERVICES <br /> 12/85 <br />