Laserfiche WebLink
} <br /> FEE WORKSHEET <br /> DBA ✓�� -' - <br /> ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. State Surcharge (per tank), (nue .:nth Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # '-L Tanks) <br /> r +ai.1 Ilnrjergrniind Stnranp TAnk 1n which <br /> 3. Temporary Closure (pie ti k') <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 d Total Fee Due Y •0 b <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, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 <br /> Total Number of Tanks 4 Total Fee D $524 19bb <br /> FEB 3 <br /> ENVIRCO-NTAL HEALTH <br /> *Both closures will be conditioned. Contact a Health District Rep jt" <br /> 12/85 <br />