Laserfiche WebLink
WORKSHEET <br /> DBA <br /> ADDRESS D 5V <br /> 1. Operating Permit Application/Annual Inspection Fee {�Q O-C <br /> a. Existing Facility and 1st Tank @ $150. Cro <br /> b. Additional Tanks (#—IL(#-ILAdditional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> crt <br /> on renewal or amendment of operation permit) <br /> ($56 x Total p S Tanks) <br /> z *Temperary Closure (per tank) Undernrniind Storage Tank ir. ,.,h;ch <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 /> (r_ Permanent Closures x $90) C -6 <br /> � lD� <br /> Total Number of Tanks 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 $ D ���� 0 <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Ia. Existing Facility & 1st Tank C g 198 <br /> b. 3 Additional Tanks x $50 FEB 2 <br /> 2. State Surcharge, 4 Tanks x $56 2G4inviROMENTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> PERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 0 <br /> 0 <br />