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- " I rLn Ln V11 rN.11lll <br /> _ FACILITY <br /> 08A: 'f l e 22� Lv r��c 2 ADDRESS r1 e.1 1 <br /> MAILING ADDRESS <br /> 1 Operating Permit Application/Annual Inspection Fee <br /> y. a ' First. Tank at Facility @ $150. <br /> b: Additional Tanks (/ Additional Tanks x $50) <br /> Z. State Surcharge (per tank) (Due with Permit Application, <br /> - on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total 0 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 0 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 . <br /> (t Permanent Closures x $90) PAYMENT <br /> RECEIVED <br /> 5. Plan Check Fee $30. -- <br /> JUN 2 2 1988 <br /> ENVIRONMENTAL HEALTH <br /> Total Number of Tanks PERMIT05R1/jf@q Due <br /> elake 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, I waste oil ) <br /> Ia. Existing Facility 6 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x; 556 224 <br /> Total Number of Tanks 4 , Total Fee Due $524 <br />