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FEE' WORKSHEET PER EACH FACILITY <br /> DBAe�DALI ✓; }} ADDRESFACILISY ' q� <br /> S STZto Gi%?vz <br /> MAILING ADDRESS�2 E �uol"J.a-a sT STkN Cq, C r2rrz <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks ,x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (#__ Additional Tanks x $50) <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # Tanks) <br /> 4. *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) (See above #3 to calculate surcharge) <br /> 5. *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 /> (#_2 Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due A 70 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet ------- <br /> with your check. ,C� 3 G� y44 S3�tf <br /> r Facility with 4 Tanks <br /> supreme, 1 waste oil) <br /> 1st Tank $150 <br /> X $50 150 <br /> LaBerge's Bruce & Jack Automotive Tanks x $56 <br /> 224 <br /> Quality AWO service Since 1960 Total Fee Due $524 <br /> SCK 4 t3E7�6E — <br /> 12 E. Poplar <br /> Stockton, Colijomia 95202 <br /> 466-.5364 <br /> *Both closures will be conditionea. contact a Health District Representative., <br />