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/FEE WORKSHEET �l'J �J �, �'� sG "• 00„ 6Ka-04` dcv"tic` of <br /> G�uc-PGL -.c-fs Gt-� <br /> DBA 6G e—7 06 rc G'-1 ,gg+4 ure <br /> ADDRESS U7�z �' v cC. l�ti / OCc�Cc, Chi 502 s�o <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 /> /pr(. Total 4 T—Ls) <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 o G a <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 2224 <br /> Total Number of Tanks 4 Total Feraw, <br /> D <br /> FEB 2 6 '(986 <br /> *Both closures will be conditioned. Contact a Health DistritNjjRM0TAgtHlFu9LTFl <br /> FERMIT/SERVICES <br /> 12/85 <br />