Laserfiche WebLink
DBA /i� /� FACILITY <br />ADDRESS i <br />MAILING ADDRESS <br />1. Operating Permit Applicatiul/Annual Inspection Fee <br />a. First Tank at Facility @ 5150. <br />b. Additional Tanks (N Additional Tanks x $50) <br />2• State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary closure) <br />(556 x Total N Tanks) <br />3• "Temporary Closure <br />(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 />(N_ Temporary closures x $80) (See above N3 to calculate surcharge) <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, <br />(N_L Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks ' 1( �i <br />Total Fee Due <br />Make all fees payable to San Joaquin local Health District Enclose this worksheet <br />with your U - <br />----------- <br />SAN JOAQUIN VALLEY REGION - <br />P.G. $ E. CO. <br />REGIONAL PETTY CASH FUND 7941 <br />' <br />EXAMPLE 1401 FULTON <br />ri FRESNO, CA 93760 —may <br />eo'ider of lS <br />U Bank of America <br />POSBw16�fpe 0010 <br />7 <br />Fres,w, CA 93717 <br />`Both closures will be conditioned. Contact a Health District Representative. <br />2-86 <br />