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FEE WORKSHEET <br /> DBA San Joaquin Lumber Go. <br /> ADDRESS — 1,55 F 11th 4+ Tracy, Ca 955376 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150.00 <br /> b. Additional Tanks (# Additional Tanks x $50) -0- <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> -(trr v <br /> T,et>,.1- # 1 T,3n4s1, _ _._ _ 56.00 <br /> 3. <br /> *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 <br /> aTotal Number of Tanks 1 Total Fee Due 206.00 <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 /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 T/ <br /> rq <br /> Total Number of Tanks 4 Total Fee Q 152U4 U O <br /> FEB 5 198b <br /> ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned. Contact a. Health District R9W9r/6WWCES <br /> 12/85 <br />