Laserfiche WebLink
AWL <br /> FEE,WORKS HEET PER EACH FACT <br /> FACT L t TY, . <br /> ADDRESS <br /> MIMONO ADDRESS <br /> I* o era. irn9 Permit Application/Annual Inspection flee <br /> a. Fi rst. flank, at-,Facility $I5�}, <br /> b. Additional. Tanks (# Additional .Tanks x ' 54j <br /> 2. ' 'State Surcharge (per,,tank)' (Due with Pe` itplt etion <br /> on renewal or amendment o operation permit and tiiiiporAry close <br /> ($56 x Total Tanks) <br /> 3. *Temporary,Closure ('per tank) Underground Storage Tank in which <br /> storage has ceased but where the er/aperaor proposes to <br /> ee®use tank within '2 years. <br /> ( Temporary closures x $8€}} (See above i3 to` cacutate,surargoj. <br /> 4* *P hent Closure, (per tank) Underground Storage Tank inrhic <br /> storage tis ceased ;and whe the er/operator, has no intent <br /> f 're csing,tnk, <br /> ( pe, rent�C�l oss x gtJ} . <br /> 5 Pl 4ii ` Check,Fe , 0, <br /> J.. <br />' Total mbe <br /> Nur of Tanks Total dee oue <br /> Make all fees a able to San Joa 'uin Local health District. Enclose this worksheet tiff <br /> P Y 9 " <br /> with your, check. <br /> 4 <br /> EXAMPLE - Annual Fee fors Facility with 4 1anks <br /> {1 regular, 1 'unleaded, I supreme. l waste oil} <br /> la. Existing Faci l,ity & Ist Tank <br /> b; 3 Acldi ticanal Tanks x $SQ ISO <br /> 2. State Surcharge, 4 Tanks $56 `224 <br /> °Total Number of Tanks 4 Total Fee Due 24 <br /> *trothlosures wt.,1 tie coneti:ticned. intact a Beath ttaiu+ : <br /> Z-86 <br /> a , <br />