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FEE WORKSHEET r <br /> DBA ©Lv6N5 - =LL (n/O / S Tom/ <br /> ADDRESS L{DQ W, V l3 LP/Co 2ci TjZ ftcy C {q '75_374 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150, ' SU <br /> b. Additional Tanks (# 'a-- Additional Tanks x $50) Q 0 <br /> 2, State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # 3 Tanks) <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 . 2 <br /> Make all fee's 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 /> 3 Additional Tanks x � f <br /> 2.. State Surcharge, 4 Tanksnks taw x $56 � LIC,/ !v� <br /> Total Number of Tanks 4 <br /> Total Fee Due $5Z4 , 3 "ado <br /> ENVIRLTH <br /> PERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Re resentative. <br /> 12/85 <br />