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Eta- W�JRK htE�T PER tm FAC 'LI <br /> MAR NG ADDRESS-: -,-- ,. <br /> 1. operating Pe it Application,Arthu l Iespectian Fee <br /> a. First Tank at, facility @ <br /> b. Additional Tanks (# Additional Tanks, x ), <br /> State Surcharge (per tank), "(Due -w th Permit Application, <br /> on renewal era n nt ctf aprttah :praiit , and tertiorary closure) <br /> —($56-i Total # Tanks) y <br /> *Temporary Closure (per:tank) Undergrdu d Storage` Tank in which <br /> storage has ceased but:where'the 'owner/ peratcr proposes to <br /> reuse tank with ,h 2 years. <br /> (# ' T tpc ra y closures,* i (Seg abai e #3 to 'a]cul ate surcharge} <br /> 4. *Permanent Closure (per tank) hdergrund Storage"Tank in wh <br /> storage has ceased Goad where` the,,ow6er - perator has, ,no intent s <br /> of re=using tank. <br /> Permanent` ci 'sures x $9U} <br /> Y ' Plan Check Fee $30. <br /> Total dumber of I Tanks Total Fee clue, " <br /> Make al fees payable to Sana Joaq, n ! , I Health District. 'Endose this worksheet <br /> with your check. cA <br /> ;. <br /> ExAMPLE - Annua:l flee gar a it ty with A Tanks <br /> (1 .regul`ar, 1 unleaded, I' supreme,: 1 waste oil ) <br /> 1a: Existing Facility 1"st Tank $150 <br /> be 3 .Additonal Tanks x $50 150 <br /> 2. State`Surcharge, LTanks x $56 224 <br /> Total Number f Tanks 4,' Total, Fee Due $524 <br /> *Bath -closures wi11 be cond:it.ioned, ;Cdntact a.;Ffealth;Distric"t Representative. <br /> Z�-a6 } <br />