Laserfiche WebLink
FEE WORKSHEET <br /> DBA _C CjiTof, nl . TVCI :� <br /> ADDRESS PO, J30X Id,() S To KTo n X15 d10 � <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (#_2,_ Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # --3 Tanks) <br /> 3. *Temporary Closure (per tank) U^dergrcund 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. *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 Number of Tanks —3 Total Fee Due <br /> Make 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, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> aW2. State Surcharge, 4 Tanks x $56 -� <br /> Total Number of Tanks 4 Total Fee Due 4 <br /> FEB 14 1�100 <br /> ENVIROMENTAALL HEALTH <br /> *Both closures will be conditioned. Contact a Health District Repres€EBA�T+G$. <br /> 12/85 <br />