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EE WORKSHEET PER EACH FA% tI"IYw <br /> FACILITY <br /> BA Jefferson School District ADDRESS 7500 Linne Rd. , Tracy, Ca. 95376 <br /> ILING ADDRESS Same <br /> 1 New Facility or Addition <br /> a. First Tank $180. <br /> Additional Tanks (# Additional Tanks x $50) <br /> perating .Permit Applicatian/Annual Inspection Fee <br /> A. Existing Facility and 1st Tank @ $150. 150.`. <br /> ^"b. Additional Tanks (# i Additional Tanks 9 $50) 50D-' <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) r <br /> . ($56 x Total # z Tanks) _ <br /> *Temporary Closure (per tank) Underground Storage Tank in which <br /> ` .. <br /> `, storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (# Temporary closures x $80) (See above #3 to calculate surcharge) <br /> *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 /> T <br /> ;Total Number of Tanks 2 Total Fee Due 312 ' <br /> ke 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 /> (1 regular, 1 unleaded, 1 supreme, l. waste oil ) <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 /> _ v <br /> Total Number of Tanks 4 Total Fee Due $5 � D <br /> A <br /> rU, MAR 2 5 Nbb <br /> , _- <br /> F ENVIROMENTAL HEALTH <br /> *Both closures will be conditioned. Contact a Health District Represent /SERVICES <br /> 2-86 <br />