Laserfiche WebLink
F i 410RKSHFET PER EACH FACIALive oak 5rhoo1 <br /> FACILITY� 5099 East =ar Crbekc Iniad <br /> CA ` 240 <br /> Lodi Unified School Dis;tq t ADDRES'S _ <br /> Lodi, ; <br /> P,,',.ILING <br /> ADORESS <br /> I New racility or Addition <br /> a, First Tank $180. <br /> b, Additional Tanks ,( Additional Tanks X450) <br /> 2 Operating Permit Application/Annual 'Inspect;ion Fee <br /> a. Existing Facility and 1,st 'Tank @, $150. <br /> h. Additional Tanks (#1 Additiphal . Tariks x $, 01) <br /> State Surcharge (per tank) d(ID;ue with Permit Application, <br /> on renewal or amendmentofoperation permit and temporary closure) <br /> ($56 x Total # Tanks) <br /> 'Temporary Closure ('per tisk) .Underaround Storage Tank in which' ' <br /> storage has ceased but: ,where the owner/operator proposes to <br /> re-use tank within Z. years'. <br /> ( t Temporary closures x $80) (See o'bove 83 to calculate surcharge) <br /> *Permanent Closure (per tank) Underground Storage Tank in which <br /> storane has, ceased and where the owner/operator has 'Ho intent <br /> of rc-�_ising tank withinhex't 2, years' 90. <br /> o.- Permanent Closu'res ,x' $90') <br /> ' <br /> notal Number of Tanks Total Fe e' Due' 90.T— <br /> e al' `ees payable to San- doaquiIn C)cal-Health, Distri4t. Enclose this worksheetXak, <br /> ,;i -,h your Check . <br /> C%AMPLE - Annual Fee for Facility with 4 Tanks , 1 11 <br /> --- <br /> 1 w rite oil ) <br /> (1 regular,, 1 u nleaded , l supreme, <br /> b150 <br /> Ia. ExistingjFaci'l'1ty & lst Tank <br /> 15'0 <br /> b. 3 Additional Tanks x $50 <br /> 224 , <br /> 2. State Surcharge', 4'Tanks ,x, $5 1 6 <br /> Total Number of Tanks 4 Total Fee Due $524, <br /> itioned. Coritacta Health District Representative. <br /> •-,,0-01 closures will be c0n d <br /> dv <br /> i <br />