Laserfiche WebLink
fEE WORK-SHLET PER EACII FACILITY <br /> FACILITY <br /> DBA e rel 41 Aj c gWI Fcei ADDRESS /a z/ L, sr 7�2.iC/ C-41 <br /> TAILING ADDRESS./P)Q- KAk:AIriAA 1�G �2nKL�1 '/l CAy uyvt�-4 S C d 9 X744 <br /> 1. Operating Permit Application/Annual inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (I 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 /> ($56 x Total / Tanks) <br /> 3. *Temporary Closure (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 l3 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. PAYMENT <br /> (/.g_ Permanent Closures x $90) RECEIVED - � <br /> 5. Plan Check Fee $30. OCT 111988 <br /> fNVA0WA64rAL HEALTH <br /> Total Number of Tanks <br /> PERMITISWICESTotalFee Due <br /> ? <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, i unleaded, l supreme, I waste oil ) <br /> Ia. Existing Facility 6 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> •Anrh rincures will be conditioned. Contact_ & Health District Representative. <br />