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ro <br /> FEE WORKSHEET <br /> DBA <br /> ADDRESS :3 . <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $15o. ...� <br /> b. Additional Tanks # _ <br /> ( 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 #�r Tanks) <br /> ��.�. <br /> 3. 'Temporary Closure (per tank) Urdergrcund Storage ;>, ,. ; <br /> Turk r�.. c.ti <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 $go) <br /> Total Number of Tanks r <br /> Total Fee Due 1 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check <br /> WW <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, l 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 <br /> 1Y/L <br /> Total Number of Tanks 4 Total Fee Due $4% <br /> p2avz <br /> T <br /> FES 18 1986 <br /> *Both closures will be conditioned. Contact a Health District Re resE NY1RQMENTAL HEALTH <br /> enf9WIT-AERVICES <br /> 12/85 <br />