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nV \hJ11LL1 VLK LAW fACILI• <br /> FAC LITr / <br /> DBA /C /)L Zz624 6)1Lz ADDRESS <br /> MAILING ADDRESS <br /> /9516 - /Skg- <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. '{50 <br /> b. Additional Tanks (d -(�- Additional Tanks x $50) 5 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 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 /3 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 /> ( NPermanent Closures x $90) <br /> 5. Plan Check Fee $30. <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 <br /> ( 1 reqular, 1 unleaded, 1 supreme, 1 waste oilj <br /> la . Existinq Facility 8 lst Tank SIYJ <br /> 1). 1 Additional Tank,, x $50 <br /> 7 . ;tate Surcharq(� , 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due SS74 <br /> 'Doth closures will be conditioned. Contact a Health District Representative. <br /> 2-146 <br /> UC-1 1 <br />