Laserfiche WebLink
FEE WORKSHEET i <br />DBA <br />�l.c�riaa� Co, <br />ADDRESS <br />w 20 <br />l• Operating Permit qPpli9`S'ag'� <br />cation/Annual Inspection Fee <br />a. Existing Facility and 1st Tank @ $150. <br />b. Additional Tanks (#- -&-Additional Tanks x $50 <br />2• State Surcharge ) <br />9 (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit) <br />(456 x Teta 1 <br />Tanks) <br />3. *Temporary Closure (per tank) Underground Storage Tank in <br />storage has ceased but where the owner/operator prowhich <br />re -use tank within 2 years. P Poses to <br />(s-!q'?emporary closures x $80) <br />4. *Permanent Closure (per tank) Underground Storage Tank in which <br />storage has ceased and where the owner/operator has <br />o intent <br />of re -using tank within next 2 years. <br />(#'Permanent Closures x $90) <br />Total Number of Tanks <br />Total Fee Due <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with your check and the completed application. <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />(1 regular, 1 unleaded, I supreme, 1 waste oil) <br />la. Existing Facility & 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />Both closures will be conditioned. contact.; <br />12/85 <br />Total Fee Due <br />Health District <br />MY <br />$150 <br />150 <br />224 <br />—Wg <br />a!0 <br />FEB 28 1986 <br />HEALTH <br />