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FEE WORKSHEET <br /> DBA Geweke Ford & RV Center <br /> ADDRESS 1045 So. Cherokee Lane &—2-yg East KeuA e=-Lane Todi ,Califnrnia 95740 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150.00 <br /> b. Additional Tanks (# 1 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 /> I Q'GG <br /> x Total rt# 2 T a"-nN <br /> �yuv �nc114 VV <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) <br /> 4. *Pernanent 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) <br /> Total Number of Tanks 2 Total Fee Due �1? nn <br /> Make all fees payable to San Joaquin Lccal 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 /> Ia. Existing Facility h 1st Tank $150 <br /> b. 3 Additional Tanks x $50 ���� <br /> 2. State Surcharge, 4 Tanks x $56 0 <br /> Total Number of Tanks 4 Total Fee Due524 FEB3 Wb0 <br /> $ <br /> E"'F'�R% C HEALTH <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />