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r <br /> FEE WORKSHEET <br /> DBA rC�iGiICad � �aUCE'lf <br /> ADDRESS 3 70 ka L o d+ CIA qS- c2 V 0 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. , <br /> b. Additional Tanks (# L <br /> L Additional Tanks x $50) a ©n, <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) /� J�fCjf <br /> f&c'C T„}.l A L T_.q l,- ` 1 VV f <br /> cK <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 /> (#0 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 /> (# 0 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 /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 qvU � <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> FEB 1 <br /> t7 1Jt� <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> ENVIROMEiiTAE HEALTH <br /> t ERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />