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FEE WORKSHEET <br /> F A q , <br /> ADDRESS �'C �<ST `/t%G#� <br /> y�, <br /> L � <br /> 1. Operating Permit Application/Annual Inspection Fee 711 <br /> r 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 /> 1$56 x Total # 9-- Tanks) f <br /> 3. *Temporary Closure (per Lank) 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 /> 10 of re-using tank within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due �a" ` <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check 11200WEEN�v <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 a <br /> ll I Ira <br /> ' - clQ�9 <br /> Total Number of Tanks 4 Total Fee Due 52� 2 ��� <br /> 40 <br /> F_NVItRQME S/ ��VIC SLi'F1 <br /> *Both closures will be conditioned. Contact a Health District RepreA p ive. <br /> 12/85 40 0 <br />