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RECEIVED <br /> JAN 17 Iyab <br /> FEE WORKSHEET CONSTRUCTION <br /> DBA Carl Karcher Enterprises <br /> ADDRESS Manteca Industrial Park, 800 Mellon, Manteca, CA 95336 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. $150 . 00 <br /> b. Additional Tanks (#_ 1 Additional Tanks x $50) 50 . 00 <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> (Crr. .. Total # 112 .�� <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 $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 /> (#_ Permanent Closures x $90) <br /> Total Number of Tanks 4 Total Fee Due $312 .00 <br /> I, Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> rwith your check and the completed application. <br /> C <br /> jF EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (i regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> Iv la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 a Y q <br /> B. V <br /> Total Number of Tanks -4 Total Fee Due 24 FEB 7 1986 <br /> C. ENVIROMENTAL HEALTH <br /> D. FERMITAERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br />{sc <br /> 12/85 <br />