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1 ......v........ . �+wriz- ^:::w•sr �,._j <br /> i . • ...� i � 4GY- 7So 8' .��� <br /> FACT L I TY <br /> • ADDRESS <br /> IMA ILiNG <br /> ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee `Cc_ <br /> a. First Tank at Facility @ SiSO . <br /> b. Additional TanksN �r13) <br /> 1 c}°" ' Goo•o� <br /> ( Additional Tanks x $50) <br /> 2. State Surcharge (per tank <br /> (Due with Permit Application, <br /> on renewal or amendment of operation <br /> ($56 x Total N '7 permit and temporary <br /> Tanks) Y Closure) <br /> 3. <br /> 'Temporary Closure <br /> (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 /> 4 <br /> (#— Temporary closures x S80) (See above M3 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 . <br /> 0 z Permanent Closures x S90 <br /> S. Plan Check Fee S30. QP.(tat <br /> $O• <br /> 0G <br /> Total Number of Tanks Z �(p.1 H <br /> V\11. `0!"�e <br /> v�I\. l ow i— <br /> ntake all fees payable to San Joa uin <br /> with 4 Local Health District Enclose this worksheet <br /> your chCCk , <br /> a <br /> EXAMPLE _ Annual Fee for Facility with 4 Tank,, <br /> ( I regular. 1 unleade(j , 1 ;u pr emq ) <br /> 1 <br /> la• Existing Facility S 1st Tank w.lste oil <br /> 1). 3 Additional Tanks x 5150 <br /> S50 ISO <br /> 2. State Surcharge.- 4 Tanks x S56 <br /> — 224 <br /> Total Number of Tanks 4 -_ --. <br /> Total Fee Due 5524 <br /> Both closures will be conditioned.- Contact a Health District R�rese_ n v� <br /> -86 <br />