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DBA <br /> ADORE .� <br /> S S <br /> MAILING nDOREss 5 3 <br /> 71 <br /> 1- Operating Permit Application/Annual inspection Fee j <br /> a. First Tank at Facility @ S15r1- ,� 7 p� <br /> b, Additional Tanks (M � Additional Tanks x $50) D <br /> Z• State Surcharge /OSI /p0 tc�Q�_ <br /> g (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total N :2--Tanks) <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 /> (r Temporary closures x $ao) (See above 13 to calculate surcharge) <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 , <br /> Permanent Closures x $90) PAYMENT <br /> 5. Plan Check Fee $30. RECEIVED <br /> JUL 12 1988 <br /> ENVIRONMENTAL HEALTH <br /> Total Number of Tanks PERMITISIr&WETee Due r <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 /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x S50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> 3th closures will be conditioned. Contact a Health District Representative. <br /> 6 <br /> R <br />