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FEE WORKSHEET <br /> DBA VA LLE Y /N19 !NC <br /> ADDRESS /3 13 SO. STOC'KTON ST. , 40126 CA . 95240 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> 00 <br /> a. Existing Facility and 1st Tank @ $150. .E O `— <br /> b. Additional Tanks (# / Additional Tanks x $50) SD <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total # 2 Tanks) <br /> J• *T{:IIIpOrai'y riu�ilrc (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 /> (#_),!f 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 /> (#_'9_1 Permanent Closures x $90) J& <br /> Total Number of Tanks Total Fee Due if3/2 <br /> SCE NOTE ON T////2D TA NK IS//N1O� RE6lSTEQED —�5- - <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 /> Ia. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 15 <br /> 2. State Surcharge, 4_Tanks x $56 22 <br /> Total Number of Tanks 4 Total Fee Due $524 MAR 4 1986 <br /> ENVIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />