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FFE W t%-44ET PER EAW FACiI .__ : ; <br /> , �4� FACILITY <br /> OU, di �'' <br /> �/�" ADORES 04 ..' AI��v`l% <br /> UNC ADORESS <br /> Operating Pemit Application/Annual Inspection Fee <br /> First Tank at Facility @ $150. <br /> b. Additional Tanks (/ A.ddit <br /> j State Surcharge 11 (per tank),{Due w1 U NOW <br /> tan renewal or anendment of operation permit and teanporary closure) ,,- <br /> Total <br /> losure)Total I Tanks) I <br /> nary Closure (per tank) underground Storage Tank in which <br /> Aerator proposes to <br /> y ; <br /> [3 to calculate surcharge] <br /> age Tank to which <br /> has no intent <br /> Permanent Closures x $90) <br /> k . <br /> lan Check Fee $30, t <br /> Al <br /> ke'a "fees payable` o"SaW' oaquIn'Loca1 Heaith"District. Enclote thf h 'iror `sheet ' <br /> AYMENT <br /> with your check. RECEIVED <br /> FEB 1 )sB�3 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks tNVIRONMENTAL HEALTH <br /> ( 1 regular, I unleaded, 1 supreme, 1 waste oil ) PERMIT/SERVICES <br /> Ia. Existing Facility b lst Tank $ISO <br /> b. ] Additional Tanks x $SO ISO <br /> 2. State Surcharge, 4 Tanks x S56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> , Doth Closures will be conditioned Contact a ficalth District Representative. <br />