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ILL tiunn.)ncu VLR LAW fACILIT <br /> FACILITY <br /> 08A 17F/YYl F 1 n�S .� ADDRESS 4 a �o L..i_y QR -r wr y <br /> MAILING ADDRESS 4jL,(- Y'VnQ 9S76 <br /> 1. Operating Permit Application/Annual Inspection Fee / - J . C or <br /> a. First Tank at Facility @ $150. <br /> b. Additional Tanks (N Additional Tanks x $50) <br /> 2• State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (156 x Total N 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 /> (N_ Temporary closures x $80) (See above N3 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 , ) D clan� nl <br /> (M Permanent Closures x 190 7 IIT j � p u'D <br /> 5. Plan Check Fee $30. OR 1 1 1988 <br /> 51a -oa <br /> ENVVV TAL M�-USERV CESTH <br /> Total Number of Tanks Total Fee Due ro t�?_�D <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 /> ( I regular, 1 unleaded, 1 supreme, 1 waste oil ) l` <br /> la . Existing Facility & lst lank 5150 <br /> b. 3 Additional Tanks x S50 150 <br /> 2. Slate Surcharge, _4 Tanks x $56 274 <br /> Total Number of Tanks 4 Total Fee Due SS74 <br /> 'Both closures will be conditioned Contact a Health District Representative. <br /> 2-86 <br /> 967 '7I <br />