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FEE WORKShEET <br />DBA <br />ADDRESS <br />1. <br />Operating Permit Application/Annual Inspection Fee <br />a. Existing Facility and 1st Tank @ $150. <br />b. Additional Tanks (# 3 Additional Tanks x $50) <br />2. <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit) <br />($56 x Total # Tanks) <br />p�o� <br />3. <br />*Temporary Closure (per tank) L:rdera;o:nd Storage Tan ii. wh;cli <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. <br />*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 Joa uin Local Health Distri t: <br />with your check - <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, 1 supreme, <br />la. Existing Facility & 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />1 waste oil) <br />nclose this worksheet <br />q0 . G <br />y e4'ci <br />$150 C k�'�� <br />150 <br />Total Fee Due 4 O <br />FEB 1 1 198b <br />ENVIROMENTAL HEALTH <br />*Both closures will be conditioned. Contact a Health District Repref MffyisEtVICES <br />12/85 <br />