Laserfiche WebLink
FEE WORKSHLET PER EACH FACILI. <br />FACILITDBA (t%%rQA%Lt% �d��liw ADDRESS Y )j Cd T <br />MAILING ADDRESS <br />1. Operating Permit Application/Annual Inspection Fee PAYMENT <br />a. First Tank at Facility @ $150. RECEIVED <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 tion ermit tNVIRONMENTAL HEALTH <br />P P and temporary RElddbIJV10ES <br />($56 x Total M 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 />(B_ 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-� Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks Total Fee Due <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with your check. <br />EXAMPLE - Annual Fee for Facility <br />with 4 Tanks <br />(1 regular, <br />1 unleaded. <br />1 supreme, 1 waste oil) <br />Ia. <br />Existing Facility <br />& 1st Tank <br />$150 <br />b. <br />3 Additional Tanks <br />x $50 <br />150 <br />2. <br />State Surcharge, 4 <br />Tanks x $56 <br />224 <br />Total <br />Number of Tanks 4 <br />Total Fee Due <br />5524 <br />*Doth closures will be conditioned <br />2-Y6 <br />�.r <br />UVT at <br />Health District Representative_ <br />I <br />09 <br />o� <br />2]0 <br />