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FEE w2Rr,SHEET PER EACH FACILITY <br /> FACILITY <br /> DBA" __$print(formerly GTE SpPRnt) ADDRESS 6855 West E�nt Mile Rd Stockton 95212 <br /> MAILING ADDRESS 3065 Gold Camp Drive Rancho Cordova. CA. 9567n Att• David Str r7 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility @ $150. 15n <br /> b. Additional Tanks (q 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 A Tanks) 56 <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 /> (A_ Temporary closures x $80) (See above N3 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 /> (N_ Permanent Closures x $90) <br /> 5. Plan Check Fee $30. <br /> Total Number of Tanks One Total Fee Due 1986 $206— <br /> T6tal Fee Due 1987 $206 <br /> Grand Total $412 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> Z <br /> with your check. pAYMEN <br /> RECEIVED, <br /> OCT 21986 <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks ENVIRONMENTAL HEM <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) PERMITISERVICES <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> e <br />