Laserfiche WebLink
�� Wynn JIILLI VLK LALH fALILITY <br /> DBA FACILITY <br /> ADDRESS �r1r��jr c Gf/ <br /> MAILING ADDRESS <br /> I. Operating Permit Application/Annual Inspection Fee <br /> i <br /> a. First Tank at Facility @ E150. _ <br /> b. Additional Tanks (d Additional Tanks x $50) _ <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> 456 x Total M Tanks) <br /> 3. *Temporary Closure <br /> (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 /> (M_ Temporary closures x $80) (See above M3 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 /> (# Permanent Closures x Ego) AYA1EVr {� <br /> 5. Plan Check Fee $30. ECE�VSD <br /> INVI E M�NRV HE'AC <br /> Total Number of Tanks 7H <br /> QFAtaI 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 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> ]a. Existing Facility & lst Tank Slat; <br /> b. 3 Additional Tanks x SSU <br /> 2. State Surcharge- , 4 Tanks S5G <br /> ,'I4 <br /> Total Number of Tanks 4 Total Fee [)w, S574 <br /> *Both closures will be conditioned, Contact a Health District Representative. <br /> 2-RG <br />�C- .21 <br />