Laserfiche WebLink
1 <br /> FEE WORKSHEET / L <br /> DBA L-1j' 4(/,4 LLe 0A S{ t le— / / <br /> ADDRESS o7.�oZ.� c 1 /T//9�'d�/ G�J/� S� �7�44AJ <br /> yf�a S <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> oa <br /> a. Existing Facility and 1st Tank @ $150. /3D <br /> b. Additional Tanks (#�d'� Additional Tanks x $50) �u— <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> (�6x Total x / Tanks) - - - — _Sam" <br /> 3. *Temporary Closurq (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) <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 within next 2 years. <br /> (# Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due <br /> 0200 .C1 O <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) D � U <br /> Ia. Existing Facility & 1st Tank $15 �J <br /> b. 3 Additional Tanks x $50 150 MAR 1 IJ6 <br /> 2. State Surcharge, 4 Tanks x $56 22LNVIR04ENTAL HEALTH <br /> --FERMI i/SERVICES <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> kc <br /> *Both closures will be conditioned Contact a Health District Representative. MAR <br /> 7 9yFlb <br /> ENVIROMENL TA <br /> 12/85 FERM11/SEH ES <br /> �,. ./ <br />