Laserfiche WebLink
0 4 <br />FEE WORKSHEET <br />DBA E -X SERVE* 030 3__. -- <br />ADDRESS G` T `:7 <br />1. <br />Operating Permit Application/Annual Inspection Fee <br />—..r <br />a. Existing Facility and 1st Tank @ $150. <br />jsc� <br />b. Additional Tanks (#� Additional Tanks x $50) <br />2. <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit) <br />($56 x Total # Tanks) <br />i tfaO r <br />3. <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 />(#_ Temporary closures x $80) <br />4. <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 within next 2 years. <br />(# Permanent Closures x $90) <br />Total Fee Due <br />4""{4 <br />Total Number of Tanks 3 <br />Make all fees payable to San Joa uin Local Health District. Enclose this worksheet <br />with your check <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 <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />*Both closures will be conditio <br />Total Fee Due <br />Health District Re <br />$150 <br />150 <br />$ <br />FEB 1 8 1986 <br />resen <br />12/85 is <br />0 <br />HEALTH <br />