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FEE WORKSH;ET <br /> DBA <br /> ADDRESS G' <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee ` yJ <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# / Additional Tanks x $50) <br /> SL' W <br /> 3, State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total #_� Tanks) <br /> 4. *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 /> 5. *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 /> 4 � <br /> Total Number of Tanks �ti Total Fee Due <br /> ONMake all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> RECUVED FED - 5 <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 /> f b. 3 Additional Tanks x $50 1 <br /> 2. State Surcharge, 4 Tanks x $56 2F <br /> I <br /> Total Number of Tanks 4 Total Fee Due $524 FEB 1 1 lybo <br /> ENVIRUMEIVTAL HEALTH <br /> F ERMIT/SERVICES <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 1-86 <br />