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IEE WORKSHEET PER EACH FACILITY <br /> FACILITY _ <br /> 06A CHEVRON USA INC . ADDRESS 2103 Country Club Stockton <br /> NAIL-iu ADDRESS c/o OIL EQUIPMENT SERVICE , PO Box 950 , San Andreas , CA 95249 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility O 1150. <br /> b. Additional Tanks (/ Additional Tanks x $50) <br /> 2• State Surcharge (per tank) (Oue with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (156 x Total I Tanks) <br /> �• <br /> *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> rt-use tank within 2 years. <br /> (/._ Temporary closures x 180) (See above 13 to calculate surcharge) <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, <br /> (/ 6 Permanent Closures x 190) 540 . 00 <br /> S. Plan Check Fee $30. <br /> Total Number of Tanks Total Fee Due 540 . 00 <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br /> with your check, -- <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( I regular, I unleaded, 1 supreme, 1 waste oil ) P A Y M E N T <br /> Ia. Existing Facility 6 Ist Tank MO RECT- `.QED <br /> b. 3 Additional Tanks x $50 ISO S E P <br /> 2. State Surcharge, 4 Tanks x 156 224 ENVIRONMEN',1, HEALTH <br /> PA4i# rJttT''CES <br /> Total Number of Tanks 4 Total Fee Due $524 RSGgIVED <br /> SEP 19 1716� <br /> *Both closures will be conditioned. Contact a Health District Representetfve. �R,41RONMENTAI HEALTH <br /> -- PERMITISERVICES <br /> 2•iif, <br />