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FEE WORKSHEETDBA J <br /> _ 4 r-, <br /> ADDRESS c(C. o) C Ct Ci <br /> r <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. S�C� <br /> b. Additional Tanks {#_ Additional Tanks x $50) <br /> 7T- <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # —� Tanks) -- -- <br /> 3. *Temporary Closure it per tank' <br /> Underground S+o. -- Twnn"L,. in which <br /> .. <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 /> / CC <br /> Total Number of Tanks Total Fee Due ( F <br /> Make all fees payable to San Joaquin 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 $56 224 t5, �� <br /> f' 1 <br /> Total Number of Tanks 4 Total Fee Due $ V <br /> ENV{ROMENTAL HEALTH <br /> *Both closures will be conditioned. Contact a Health District RepresentpgM SERVICES <br /> 12/85 0 <br />