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FEE WORKSHEET <br /> DBAl�L`� <br /> ADDRESS L} !If�` �p'�vdPVA <br /> �' TfyG � <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 41 VQ <br /> b. Additional Tanks (# 2• Additional Tanks x $50) 4100 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # Tanks)3. 6j <br /> mnnv+,r... ('Z..r i.r r. fnn.n i•-..n li} ��in�e�nn�-..n..:.Ind C.4 vv+-n TwrSL in L.�..h <br /> !jc <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 /> Make all fees payable to San Joaquin Local Health District, Enclose this worksheet <br /> with your checkMONNEMEMUM <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (I regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank 0 <br /> b. 3 Additional Tanks x $50s a <br /> 2. State <br /> Surcharge, 4 Tanks x $56 0$2 4 <br /> ------FER 2 8 19$6 <br /> Total Number of Tanks -4 Total Fee Due ��$$�� <br /> ENVf��Mr:NYRL HEALTH <br /> PERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative, <br /> 12/85 <br />