Laserfiche WebLink
t <br />FEE WORKSHEET <br />DBA /1' S o -� <br />ADDRESS / 32 9,!!E,G� <br />�• <br />1. <br />Operating Permit Application/Annual Inspection Fee <br />a. Existing Facility and 1st Tank @ $150., <br />pU <br />b. Additional Tanks (# 3 Additional Tanks x $50) <br />2. <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit) <br />(k";r, v T-+;31 �� T- .Ikl 1 <br />v• v • U J <br />Ga <br />\Y" <br />3. <br />*Temporary Closure (per tank) Underground Storage Tank in <br />which <br />storage has ceased but where the owner/operator proposes <br />to <br />re -use tank within 2 years. <br />(# Temporary closures x $80) <br />4. <br />*Permanent Closure (per tank) Underground Storage Tank in <br />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 />Total Number of Tanks Total Fee Due 00 <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, l supreme, 1 waste oil) <br />la. Existing Facility & 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks -4 <br />Total Fee Due <br />l 'ci <br />MAR 4 1986 <br />224 <br />-€NlttlWrOE!vTAL HEALTH <br />$524FERrV YSERVICES <br />*Both closures will be conditioned. Contact a Health District Representative. <br />12/85 <br />