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FEE WORKSHEET l d <br /> DBA WAR CN <br /> ADDRESS ( y LI c-I /A; ))CAI/ C/� <br /> 1. Operating Permit Application/Annual 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 /> czs? 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 /> Tot 1 Number of/Tanks p Total Fee Due AIL <br /> Make all`fees payable to` San Joaquin Loc;1eaea t�. 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 $56 224 <br /> Total Number of Tanks 4 Total Fee Due $52 <br /> iydo <br /> *Both closures will be conditioned. Contact a Health District RepresentatiJAN 1 U <br /> ve. <br /> / ENVikury E!v i AL.HEALTH <br /> 12/85 FERMIT/SERVICES <br />