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FEE WORKSHEET o <br /> DBA Pacific Molasses <br /> r . 9520 <br /> 2115 �'l. Washington Stockton, <br /> ADDRESS <br /> o <br /> Application/Annual 1, Operating Permit App l Inspection Fee $150-00 <br /> a. Existing Facility and ist Tank @ $150. <br /> Additional Tanks x $50) <br /> b, Additional Tanks (#. Application, <br /> 2, 'State Surcharge (per tank) (Due with Permit APP <br /> on renewal or amendment of operation permit) 56 00 <br /> --�$56 x Total #- - - 1 <br /> Tanks) <br /> 3, *Temporary closure (per tank) Undernround 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 /> "acv: f llod with sand & sealed <br /> of re-using tank within next 2 years• with concrete--March t $4• ) 0C <br /> (#� Permanent Closures x $90) 749 <br /> Total Fee Due <br /> Total Number of Tanks ��, a <br /> 1 fees •a able t aJoaquin <br /> LocalYHeal *h District. Enclose this worksheet <br /> Make al P San y A � <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> 1 1 ) <br /> (1 regular, 1 unleaded, 1 supreme, waste o $150 <br /> la. Existing Facility & 1st Tank <br /> 150 <br /> b. 3 Additional Tanks x $50 224 } <br /> $56 <br /> 2. State Surcharge, 4 Tanks x <br /> Total Fee Due $5 � „r r, ;;AL HF.,"LTH <br /> Total Number of Tanks 4 F F /S E VICES <br /> th closures will be conditioned. Contact a Health District Representative. <br /> *Bo <br /> 12/85 <br />