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MAILING ADDRESS :7tochtcn, �7- 0 <br />Operating Permit Application/Annual Inspection Fee <br />a. First Tank At Facilitv P S15n. <br />b. Additional Tanks (I Additional Tanks x $50) <br />State Surcharge (per tank) (Due with Permit Application. <br />on renewal or amendment of operation permit and temporary closure) <br />(5.56 x Total I Tanks) <br />'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 />(I Temporary closures x $80) (See above 13 to calculate surcharge) <br />'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 />(I ; . Permanent Closures x $90) RECEIVED <br />Plan Check Fee S30. AUG 11988 <br />_ENVIRONMENTAL HEALT14 <br />PERMIT/SERVICES <br />Total Number of Tanks one (I) 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 with 4 Tanks <br />(1 regular, I unleaded. 1 supreme, <br />Ia. Existing Facility b 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge. 4 Tanks x S56 <br />Total Number of Tanks 4 <br />1 waste oil) <br />Total Fee Due <br />'doth closures will be conditioned. Gontact.a Health District Representative. <br />