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FEE WORKSHEET <br /> DB,',1 <br /> ADDRESS _ ��_ _ u (��1�1 1 C._ -I 6 S 40 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. _ <br /> b. Additional Tanks (#� Additional Tanksx $50) 1 � <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or am'e'ndment of operation permit) lJI <br /> ky�v 7x Total r� IdnRs� <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. 1 �} <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 /> 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 /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanxs x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 CRW <br /> T Total F Due 524 <br /> Total Number of Tanks 4 o ,al ee $ <br /> FEB 3 lybo <br /> ENVIROMENTAL HE$TH <br /> *Both closures will be conditioned. Contact a Health District RepresentatfE MIT/SERy <br /> 12/85 <br />