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y 00 ed <br />FEE'WORKSHEET <br />DBA USA PETROLEUM CORPORATION #65 <br />ADDRESS 2500 W. LODI, LODI, CA 95240 ------------ <br />OUR MAILING ADDRESS IS: P.O. BOX 1839, SANTA MONICA, CA 90406 <br />1. Operating Permit Application/Annual Inspection Fee <br />a. Existing Facility and 1st Tank @ $150. <br />b. Additional Tanks (# 11— 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 # 3 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 <br />Total Fee Due <br />Make 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, 1 waste oil) <br />la. Existing Facility & 1st Tank <br />b. 3 Additional Tanks x $50 <br />2. State Surcharge, 4 Tanks x $56 <br />Total Number of Tanks 4 <br />Total Fee Due <br />���' Da <br />/OD, °a <br />p <br />— o <br />$150 <br />4 Cralyz0 <br />$52f EB 3 198b <br />ENVIROMENTAL HEALTH <br />PERMIT/SERVICES <br />*Both closures will be conditioned. Contact a Health District Representative. <br />12/85 0 <br />0 <br />