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MAR 5 a C,EIVEB JAW I L 1"'L14FEE WORKSHEET <br /> DBA WESTERN OIL & SREADING INC. <br /> ADDRESS 19256 N. Hwy 99 ACAMPO CALIF. 952201. l <br /> Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. $ 150 . 00 <br /> b. Additional Tanks (# 2 Additional Tanks x $50) $ 100. 00 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # 3 Tanks) $ 168 . 00 <br /> 3. -Temporary Closure (per Lank) ur,dei-C,!-Ounud Storage Tarek iii 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 3 Total Fee Due $ 418 . 00 <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 � � 1u� <br /> b. 3 Additional Tanks x $50 -to <br /> MAR 7 1980 <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> —EiQVtf'tBMEN1TAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $5AER1,.411/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />