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, <br /> FEE WORKSHEET <br /> DBA Sou7NE2N �A��/�/c /,2A14Sa2T,47ianu o�rPANy <br /> ADDRESS / /'Y 4el4G7 /LAZA �26oM Md JAU /PlWUScc� �A. 9¢�0T <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 /> ($56 x Total #1_ Tanks) �G <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 l Total Fee Due ��6 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> ' with your check 2111! <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 ---���a��-'V <br /> Total Number of Tanks 4 Total Fee Due l�f 24 MAR 5 198b <br /> ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned. Contact a Health District Representa [d��SERVICES <br /> 12/85 <br /> • <br />