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LING ADDRESS <br />FACILITY <br />ADDRESS <br />In <br />Operating Permit Application/Annual Inspection Fee PA YMEyr <br />a. First Tank at Facility Q $150. RECEIVED <br />b. Additional Tanks (/ Additional Tanks x $50) JUL 2 2 1988 <br />State Surcharge (per tank) (Due with Permit Application,RON <br />on renewal or amendment of operation permit and temporary clog jT/•�Vj E, TM <br />($56 x Total N Tanks) <br />*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 />(1 Temporary closures x $80) (See above 13 to.calculate surcharge) <br />_--- <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 />�a <br />(N i Permanent Closures x $90) <br />Plan Check Fee <br />Total Number of Tanks Total Fee Due <br />_ ►_____ <br />ake all fees payable to San Joaquin local Health District. Enclose this worksheet <br />ith your check. <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(I regular. 1 unleaded, l supreme. 1 waste oil) <br />Ia. Existing Facility b 1st Tank 5150 <br />b. 3 Additional Tanks x $50 ISO <br />2. State Surcharge, 4 Tanks x S56 224 <br />Total Number of Tanks 4 <br />Total Fee Due $524 <br />Both closures will be conditioned. Contact a Health District Rel!resentative. <br />IM <br />