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FEE kr"XSHLET PER EACH FACILITY <br /> 08A J /1 FA <br /> L& S. CI <br /> 0RES5 J 1�k� <br /> HAILIN6 ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank At Facility P $150. <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Oue with Permit Application. <br /> �t retiewal or amendment of operation permit and temporary :Ios�,re) <br /> (356 x Total f 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 , PAYMENT <br /> (11L Permanent Closures x $90) RECEIVEDQgnQQ- <br /> -S. - -f.at� Check Fee $3O. NOV 1997 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT(SERVICES 990 <br /> Total Number of Tanks Total Fee Oue 7 <br /> Hake all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check . <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular. I unleaded , 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility b ist Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br />