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FES WORKSHEET <br /> DBA —7 <br /> ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fees <br /> a. Existing Facility and Ist Tank @ $150, Q <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 Tnta1 # Tanks) ,fir <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 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 /> e4ob-� 401-) <br /> Make all fees <br /> payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (I regular, I 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 <br /> r r <br /> Total Number of Tanks 4 , R'17 <br /> Total Fee ue $ ?4 a <br /> r EB 2 i 1Ydb <br /> *Both closures will be conditioned. Contact a Health District Represent IRG ;r��AL HEAL <br /> SERVICES <br /> 12/85 <br />