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' T <br /> FEE WORKSHEET <br /> DBA <br /> 2- <br /> ADDRESS Qti4 d�' 953�� <br /> i <br /> 3 33-da 9� <br /> 1. Operating Permit Application/Annual Inspection Fee o <br /> a <br /> a. Existing Facility and 1st Tank @ $150. 5S6 <br /> b. Additional Tanks (# d Additional Tanks x $50) 16_0a_ <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) as <br /> ($56 x Total #�� Tanks) <br /> 3. *Temporary Closure (per tanK)u d -- n-age_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 /> 06 <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 0 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, I 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 $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> JAN 1 22 <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> LINVIKUMLNIAL HEALTH <br /> FERMIT/SERVICES <br /> 12/85 <br />