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FEE WORKSHEET OR 1 M A - CAST& MFG. INC. • <br /> DBA ___ OuaiNy CProducibn <br /> M hin <br /> DBA- Schmidt'a unnding d Will. _ <br /> ADDRESS 1220 E. Pine Street, Lodi, Calif. 95240 <br /> 9-7oyy <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <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 Tot.-I - ty_ <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 /> (N '�/' Permanent Closures x $90) <br /> 90A''.0 <br /> Total Number of Tanks <br /> Total Fee Due Omp <br /> Make all fees payable to San J a uin 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 /> la. Existing Facility & 1st Tank <br /> b. 3 Additional Tanks x $50 150 <br /> $150 <br /> 2. State Surcharge, 4 Tanks x $56 22244 <br /> Total Number of Tanks 4 <br /> Total Fee Due $524 <br /> *Both Closures will be conditioned, Contact aHealt�rict Representative. <br /> 12/85 7i9,QK C�psv2c <br /> 444 T7 <br /> -1 azo-,10 <br />