Laserfiche WebLink
SEE WORKSHEET PER EACH FACILITY <br />FACILITY � � <br />A v^. p?'ri �vv DRESS 3 `Loci <br />6 <br />4AILING ADDRESS Sb <br />1. Operating Permit plication/Annual Inspection Fee <br />a. First Tank at Facility p $150. <br />b. Additional Tanks (% 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 />($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 />(/ 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 gwner/operator has no intent <br />of re -using tank. <br />(A , <br />Permanent Closures x $90) <br />5. Plan Check Fee $30. <br />Total Number of Tanks _�� 6 TA ° Total Fee Due <br />` C0� <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />with your check. <br />PAYMENT <br />RECEIVED <br />EXAMPLE - Annual Fee for Facility with 4 Tanks NOV 15 1988 <br />(1 regular, 1 unleaded, I supreme, 1 waste oil) <br />Ia. Existing Facility & 1st Tank .EISA MENTAL HEALT14 <br />b. 3 Additional Tanks x $50 '1 IT/SERVICES <br />2. State Surcharge, 4 Tanks x $56 224 <br />Total Number of Tanks 4 Total Fee Due $524 <br />*Both closures be conditioned. Contact a Health0 istrict Representative. <br />2 -:.f, <br />UG"r a r •., <br />