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Y <br /> FEE WORKSHEET <br /> DBA PL YM0 <br /> ADDRESS 1319 N. Madison Stockton , CA <br /> 95202 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks ( Additional Tanks x $50) 1150. 00 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($5F v Tota! t run�rc 1 <br /> 3. Temporary Closure (� � _ n0 <br /> 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 /> (0_ 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 /> (TM Permanent Closures x $90) <br /> Total Number of Tanks 1 <br /> Total Fee Due $206 . 00 <br /> Make all fees payable to San Joaquin 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 /> Ia. Existing Facility & 1st Tank ff <br /> b. $1517�f�� <br /> 3 Additional Tanks x $50 ti <br /> 2. State Surcharge, 4 Tanks x $56 224 [Ji AR +:00 <br /> ENVIROMENTRL HEALTH <br /> Total Number of Tanks 4 <br /> Total Fee Due $524 FERMI T/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />