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WTI <br /> FEE WORKSHEETg <br /> DBA <br />■ ADDRESS. . V y r96'�q-.0-14"�" <br /> r <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a.- Existing Facility and 1st Tank @ $150.' _.� °— Iry, <br /> b. "Additional Tanks (# Additional' Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> �c !! <br />{ _ 3. *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased .�ut 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 ' T <br /> storage has ceased and where the owner/operator has no intent <br /> of rd--using tank within next 2 years. g' <br /> x� <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 /> withyour check and the completed application, � <br />�L t <br /> n <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (l regular, l unleaded, 1 supreme, 1 waste oil ) ' <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 l 1 D t`04%�k-.k <br /> 2. State Surcharge, 4 Tanks x $56 2 <br /> }}����(( SFJ <br /> FF . <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> ENVIROMENTAL HMI%. <br /> T ` <br /> F ER <br /> fi►fit lSERNIt <br /> ' r <br /> *Both closures will be conditioned. Contact a Health District Representative. ; ;�� <br /> 12/85 <br /> i <br /> �a L <br /> Cg j <br />