Laserfiche WebLink
Joe <br /> FEE WORKSHEET — <br /> DBA Z /Jl y/ <br /> Cr ✓ amu c,i� <br /> ADDRESS P_D_ <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) Q <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> pu <br /> ($56 x Total # Tar,1-s <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 /> 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 /> Jv <br /> Total Number of Tanks / Total Fee Due o?D 6- <br /> Make <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. <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 $56 224 <br /> 'dl !-dti <br /> ry <br /> Total Number of Tanks 4 Total Fee Due $5 <br /> JAN 2 1 198b <br /> ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned. Contact a Health District Representqb T/SERVICES <br /> 12/85 <br />