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ir'L WORI.SHEL1 PER EACH FACIL. <br /> FACILITY <br /> DBA John J. Serpa ADDRESS 85 E Louise Ave. , Lathrop, CA 95330 <br /> MAILING ADDRESS 2000 Alameda De Las Pulgas, San Mateo, CA 94403 <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150 <br /> b. Additional Tanks (# <br /> 3 Additional Tanks x $50) 150 <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 4 Tanks) 224 <br /> 4. *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) (See above #3 to calculate surcharge) <br /> 5. *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 /> S24•vo <br /> Total Number of Tanks 4 Total Fee Due _ <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 $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 2 <br /> Total Number of Tanks 4 Total Fee Due $5 �4 <br /> APR 1 6 198b <br /> ENVIROIViETVTAL HEALTH <br /> FERMI*Both closures will be conditioned. Contact a Health District RepresentativSERVICE S <br /> 2-86 <br />