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FEE WORK5HEE'I <br /> DBA 'ST cz 0Kv `.1eI� <br /> ADDRESS S7 Z -2-7 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility ,and 1st Tank @ 5150. <br /> b. Additional Tanks (4. 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 # 4 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 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 Tota] Fee Due 2-06.. <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet "'� v <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> 1a. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> "-- .e Surcharge, 4 Tanks x $56 224 <br /> her of Tanks 4 Total Fee Due $524 <br /> A l <br /> Y r� J p J. <br /> *Both cl osur �condi boned; Contact-a Health District Re resentatve�. =� -_ <br /> 12/85 <br /> - i - <br /> 1 9 <br />