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FEE WORKSHEET <br /> DBA Interstate Truck Leasing Corp. <br /> 1137 S. Stockton St. , Stockton, CA 95206 <br /> ADDRESS <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. Jp 'Q d <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) q <br /> ( �F Y Tn+ul # Tn -7 <br /> y..v 4a. Vs <br /> I�f\J <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 $800 <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 I Total Fee Due S �-oc) <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, I 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 /> r <br /> $5 <br /> Total Number of Tanks 4 Total Fee Due <br /> ,5 f <br /> JAN 2 <br /> *Both closures will be conditioned. ;ontact a Health District RepreserEW��-NTAL HEALTH <br /> S TiH <br /> 12/85 <br />