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FEE WORKSHEET <br /> DBA Q. J. J • C4M4PA4J� !_r JJG ___ <br /> /�awc <br /> ADDRESS.2y 3( C. MAetPoSR 29 .� STOCk7'*'.. CA9S2os"�__ f�6•f�pX �(L7rSTrr�CTi�y9��b$ <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. /SO <br /> b. Additional Tanks (#_/ Additional Tanks x $50) SO <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> 6 x Total # Z 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) b` <br /> Total Number of Tanks 2 Total Fee Due <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, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 r/�► <br /> 2. State Surcharge, 4 Tanks x $56 �* U <br /> Total Number of Tanks 4 Total Fe�e $524�i �� <br /> FEB 5 1986 <br /> ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned. Contact a Health DistrictF 1MVIPi$. <br /> 12/85 <br />