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• <br /> FEE WORKSHEET <br /> DBA <br /> ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee IS0 <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (#___L_ 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 # _ Tanks) 11�ma <br /> 3. *Temp ,r2ry �l sure (no, +unL) Underrrs oljnd Storane Tank in 1,hi ch <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 <br /> 3_ <br /> Make all fees payable to San Joa uin Local Health District. Enclose this worksheet <br /> with your check <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 <br /> a RA <br /> Total Number of Tanks 4 Total Fee Dug � . <br /> F.NIi1ROMEWAL HEALTH <br /> *Both closures will be conditioned Contact a Health District Repr <br /> PPM1 ICES <br /> 12/85 0 0 <br />