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FEE WORKSHEET / <br /> DBA �(1�/l�al✓ �0z� eG �O� �iy /,�� 13 C/ <br /> ADDRESS O q o DC / 0 7 T✓ rrc � �/� 91�0'� y <br /> 1. -Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. /fid-o 0 <br /> b. Additional Tanks (# Additional Tanks x $50) So, Oro <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 k) L' ,,,.rd Storage —off <br /> Closure aper tan�� ndc, c �,e Tank in �,;�ich <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 3 /a ,0 0 <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 � <br /> b. 3 Additional Tanks x $50 Zap <br /> 2. State Surcharge, 4 Tanks x $56 2P <br /> Fru 4MAR 41986 <br /> Total Number of Tanks 4 Total Fee Due l -ViENTAL HEALTH <br /> RIAIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />