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FEE WORKSHEET <br /> DBA ?#?- <br /> ADDRESS /4808 -P 'Ckia r 9+-aa9 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. ISo <br /> b. Additional Tanks (# 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) <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 ceas a where the owner/operator has no intent <br /> of re-using to 2 years. <br /> (#_ Permar <br /> Total Numh * ` = Total Fee Due 7,0 , <br /> Make all f/ District. Enclose this worksheet <br /> with your <br /> EXAMPLL Tanks <br /> (1 - )reme, 1 waste oil ) <br /> la. ExisL. c Tank $150 <br /> b. 3 Additiona � — $50 <br /> 2. State Surcharge, 4 anks x $56 24 U <br /> 14 Z 1 1986 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />