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�. ._100 <br /> I`.9APERY AND CARPET C"E EGS <br /> FEE WORKSHEET 1148 ENTEFPRISE STREET <br /> STOCKTON.CALIFORNIA 852D4 <br /> DBA <br /> Telephone 209/466-5371 <br /> ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> f o, <br /> a. Existing Facility and 1st Tank @ $150. �J Q <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total' # Tanks-} <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. *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) <br /> Total Number of Tanks / Total Fee Due 0 a <br /> ',.•, <br /> , <br /> 00e 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 15 <br /> aq2. State Surcharge, 4 Tanks x $56 p ' <br /> Total Number of Tanks 4 Total Fee Due 52! 'r" Iydb <br /> u ENVIRONIENTAL HEALTH <br /> FERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />