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FEE WORKSHEET Tank Location: <br /> DBA J. R. Simplot Comapny dba Simplot Soilbuilders <br /> ADDRESS 4863 E. Carpenter Road Stockton Ca 95205 4863 E. Carpenter Road <br /> p Stockton, 6e 95205 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150.00 <br /> b. Additional Tanks (#_j__ Additional Tanks x $50) 50.00 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total #? Te'k,) 117.00 <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) -0- <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 within next 2 years. <br /> (#_ Permanent Closures x $90) _0_ <br /> Total Number of Tanks 2 Total Fee Due 312.00 <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, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 avTO <br /> Total Number of Tanks 4 Total Fee Due 524 0 <br /> F E 8 7 198b <br /> ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned. Contact a Health District Repr2csMgL DOES <br /> 12/85 <br />