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0 <br /> FEE 'WORKSHEET <br /> DBA S'7'-OrV = vs I dSSd61dh!7!i <br /> ADDRESS ;--w� � 1 1/E1`lYMV � T r`r` Cdr. `I's:'20 , <br /> �57 57 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# �I, Additional Tanks x $50) - <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> M6 x Total #3 Tanks) /�c�• 4 <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 /> (#—Q 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 <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 /> Ia. Existing Facility & lst 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 /> "1 <br /> *Both closures will be conditioned. Contact a Health District RepresentatiyPN 2 1 1986 <br /> ENVIR0MENTAL HEALTH <br /> 12/85 FERC I-T/SERVIiCES <br />