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F"M <br /> 4, <br /> 1W <br /> A ' -s 4, <br /> FEE WORKSHEET <br /> DBA <br /> S <br /> ADORES ,2r <br /> 1. Operating Permit Application/Ann6al Inspection Fee <br /> a Existing Facility and ist .Tank @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) 'rsa <br /> 2. State Surcharge- (per tank) (Due with Permit Application, <br /> WIF; <br /> on renewal or amendment of operation permit) <br /> x Total # Tanks) <br /> .3 'Temporary Closure 'per tanK)i ' Under oui <br /> storage has ceased but where the owner/operator proposes to <br /> re ru s e tank within 2 years. <br /> Temporary closures X $80), <br /> 4. *Permanent Closure (per tank) L d Le i-,g r ou n d Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> -of re-using tank within next 2 <br /> years. <br /> Permanent Closures x $90) <br /> 0 <br /> Total Number of Tanks Total Fee Due <br /> A. <br /> A <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check <br /> 77�1 <br /> EXAMPLE,.' Annual Fee f6r Facility with 4 Tanks <br /> (1 regular, 1 unleaded, I supreme, 1 waste oil ) <br /> la. Existing Facility & Ist Tank $150 <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> Total Fee ,Due 1986 <br /> pR <br /> - <br /> Total Number of Tanks 4 $52 <br /> ENVIROMENTAL HEALM, <br /> FERMITii <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />