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rEE YORRSHEET FUER EACH FACILITY • <br />IPAILING ADDRESS 94 l6 <br />II <br />1 Z. <br />1 3. <br />4. <br />5 <br />E <br />FACtL1Iy <br />C o --fD <br />Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $150. <br />b. Additional Tanks (f Additional Tanks x $50) <br />State Surcharge (per tank) <br />Due with Permit Application. <br />on renewal or amendment of operation permit and temporary closure) <br />($56 x Total ! Tanks) <br />`Temporary Closure (per tank) Underground Storage Tank in which <br />es to <br />storage has ceased but where the owner/operator propos <br />re-use tank within 2 years. <br />(#_ 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. <br />(r_ Pe:Tranent Closures x $90) <br />Plan Check Fee $30. <br />Total Number of Tanks <br />Make all fees payable to San Joaquin Local Health District. <br />with your check. <br />FRANKLIN MAINTENANCE <br />& EQUIPMENT CO. <br />1450 CCLUSA .AVE. 916-673-9253 <br />YUBA CITY. CA 95991 <br />Total Fee Due <br />Enclose this worksheet <br />1014 <br />90-6125/Ot <br />3211 <br />ell S—J $ <br />'DOLLARS <br />BUTTER BUTTES SAVINGS <br />---- w...a. T <br />S <br />v.n.slp(qpNASSOCI,kTj0N <br />i <br />11100 Lo I L, <br />FOR �— �+^7: i �r nn ❑�I� <br />32118:2c5s: <br />