Laserfiche WebLink
FEE WORKSHEET <br /> DBA ��-\-� <br /> ADDRESS w <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a) <br /> a. Existing Facility and 1st Tank @ $150. <br /> co <br /> b. Additional Tanks (# Additional Tanks x $50) 1 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total #_3 Tanks) 1 — <br /> _ .. a., .--_. pe ,__.._._ [___..s..__[.1. llnrior�n�^nnnrl cz}'nrann. Tana in. which <br /> 3. ' Iempourary -41W{[Iv (PCI Bann[ ��•.- _ �-. -�� ... ... -. <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 J Total Fee Due Q <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check ow <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 }�1� <br /> 2. State Surcharge, 4 Tanks x $56 22 V Lx� it <br /> Total Number of Tanks 4 Total Fee Due $52 198b J <br /> ENVIROMENTAL HEALTH <br /> F ERMIT/SERVICES <br /> 11 *.Both closures will be conditioned Contact a Health District Representative. <br /> t <br /> '12/85 <br />