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FEE,WVRKSHEET <br /> DBA JIM THORPE OIL, INC. , P. 0. Box 357, Lodi , CA 95241-0357 N f�-Tl�o P.Q'Qo <br /> ADDRESS Key Lock Location: 600 W. Lockeford Street, Lodi , CA 95240 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150.i1n <br /> b. Additional Tanks (# Z 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 Tctel 3; Tanks) C �L�, , <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 /> (# 1 Permanent Closures x $90) 90.00 <br /> Total Number of Tanks 4 Total Fee Due $508,00 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet 'r'R <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks a <br /> y � <br /> (1 regular, 1 unleaded, 1 supreme, 1 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 /> Total Number of Tanks 4 Total Fee Due $524 <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />