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FEE 'WORKSHEET PER EACH FACILITY . <br /> FACILITY <br /> DBA. ADDRESS <br /> MAILING ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (R Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit andtemporary closure) <br /> ($56 x Total I 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 /> ((_ Temporary closures x $80) (See above /3 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 /> 90 <br /> (l / Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks /� <br /> Total Fee Due 9Q <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check. <br /> PAYMENT <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks R E C EIV E D <br /> ( 1 regular. 1 unleaded, 1 supreme. 1 wast <br /> la. Existing Facility 6 1st Tank 50 <br /> b. 3 Additional Tanks x $50 ENVIRONMENTAL HaARfHPERMIT/$RVICEj24 <br /> 2. State Surcharge. 4 Tanks x $56 <br /> Total Number- of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> EH 23 032 2/86 <br />