Laserfiche WebLink
FEE WORKSHEET <br /> DBA A -,`I^J F'/=1-c 6M6 CC) . <br /> ADDRESS 9900 LOc,,,45 9- ICNTo p� Seo c�nl , C A- 9 S� I a <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150, So, "- <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # / Tanks) Ps.¢, --�-�-- <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) <br /> 1. *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 Total Fee Due <br /> flake all fees payable to (an Joaquin Local Health District. Encl se this worksheet <br /> vith your check and the comple tion. .,,G�. <br /> --_- � <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 5IL <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 22A <br /> Disc .�cz.b.<. s <br /> Total Number of Tanks 4 Total Fee Due 4 . :-:..., e `-W. :.- . .,. _._ .J <br /> °Both closures will be conditioned. Contact a Health District Repr ent41 vU j <br /> 12/85 ENVIRONENTAL HEALTH <br /> FERMIT/SERVICES <br />