Laserfiche WebLink
,. - -- • rl� 1-nu1 rALILI lr ... <br /> DBA FACILITY <br /> 1- ADDRESS <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <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 and temporary closure) <br /> (S56 x Total / 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 /> Temporary closures x $80) (See above /3 to calculate surcharge) <br /> 4• `Permanent Closure (per tank <br /> Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank <br /> (K_ Permanent Closures x $90) <br /> 5. Plan Check Fee S30. <br /> Total Number of Tanks <br /> Total Fee Due /L G✓ <br /> Make all fees Payable to San Joa uin <br /> with — o Local Health District Enclose this worksheet <br /> your Check <br /> EzAM�tr _ Arinoa 1 Frio for Faci 1 i ty w t 4 Tank; <br /> reQuIIr . I unlea4e4 . <br /> I wa•, C•` :til ) � � �� �Q <br /> d . Existing Facility ,S ISC Tani SI'M4Q/t12-4 <br /> �l��� 414 <br /> 3 ;.]rltCional Tanks x $50 <br /> Starr i5n /. rqC <br /> Sturcha rqn , 4 Tanks x $56 �C' g,• <br /> — <br /> Total Number of Tanks 4 <br /> — Total Fee Due $524 <br /> v 101 <br /> 'Both closures will be conditioned. <br /> Contact a Health District Representative. <br /> 2-136 <br /> 1C� ;II <br />