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E WORKSPSi;t-y x 7 1 4 Kmart <br /> 2180 EAST MARIPOSA ROAD <br /> A <br /> DRESS , <br /> Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b, Additional Tanks (#. _ Additional Tanks x $50) <br /> State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ($56 x Total #__L__- Tanks) <br /> *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) <br /> *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 /> (#_I__ Permanent Closures x $90) <br /> Total Number of Tanks Total Fee Due /� ) <br /> Cl 0 . o0 <br /> ke all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> th your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 TanksL9;'. <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 <br /> 150 <br /> MAR 1 G iyd6 <br /> 2. State Surcharge, 4 Tanks x $56 224 ENVIRUMEi,JAL HEALTH <br /> FERMI i/SERVICES <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> )th closures will be conditioned. Contact a Health District Representative. <br /> /85 0 0 <br />