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FEE WORKSHEET <br /> DBA figA 'r Arne21 c,4vj f i ', L(. <br /> ADDRESS LT) M- A(-,)-"THLA0— '66ULVA-nt} L 'a l'' 7�137& <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# C Additional Tanks x $50) so (r.0 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) //�� <br /> I AF v 7nt'?1 ItT�rd,c !`.00 <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 I Total Fee Due 00 <br /> Make all fees 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 /> (1 regular, 1 unleaded, I supreme, 1 waste oil ) <br /> 1a. Existing Facility 8 lst Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge,- 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 �i <br /> JAN <br /> *Both closures will be conditioned. Contact a Health District Represents ve. . <br /> :vet,:a i AL HEALTH <br /> F ERIA11/SERVICES <br /> 12/85 <br />