Laserfiche WebLink
FEE WORKSHEET PER EACH FACIL11"r <br /> FACILITY V4x1 <br /> DBA [ IVV ADDRESS Mays�on R✓e. <br /> MAILING ADDRESSl �7 t� l-1 4G� +��m 31Z CA 9S2,9Z _ <br /> 1. New Facility or Addition <br /> a. First Tank <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2.. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# / Additional Tanks x $50) 50 <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 2 Tanks) <br /> 4. *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 /> 5. *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 2 Total Fee Due 3/2 <br /> C4 d_� <br /> K,ke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> -rIih your check. <br /> EXAMPLE - Annual Fee..f(ar Facility with 4 Tanks w. <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) D <br /> Ia. Existing Facility & 1st Tank L/ ImVI U <br /> b. 3 Additional Tanks x $50 , 15IIr 2 8 1J�b <br /> 2. State Surcharge, 4 Tanks x $56 2�4A <br /> — NM)mENTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $161WAIT/SERVICES <br /> *Both closures will be conditioned Contact a Health District Representative. <br /> 2-86 11,. "� <br />