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r Lc WUkkK )HLL I PER EACH FACILI <br />FACILITY <br />DBA CHEVORN USA, INC. ADDRESS 2905 W. BENJAMIN HOLT STOCKTON CA <br />MAILING ADDRESS 2 ANNABEL LANE, SUITE 200, SAN RAMON, CA 94583 <br />I. Operating Permit Application/Annual Inspection Fee <br />a. First Tank at Facility @ $15Q. 150 <br />b. Additional Tanks (N__2_ Additional Tanks x $50) 100 <br />2. State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary closure) <br />($56 x Total M 3 Tanks) 168 <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 />(N - Temporary closures x $80) (See above 13 to calculate surcharge) N/A <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. <br />Permanent Closures x $90) PAYMENT 360 <br />RECEIVED <br />5. Plan Check Fee $30. 30 <br />MIRQNMENTAL HEALTR <br />Total Number of Tanks REMOVE 3, ADD 3 IT/SERVICES Total Fee Due $0$ <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, I supreme, 1 waste oil) <br />Ia. Existing Facility b 1st Tank 5150 <br />b. 3 Additional Tanks x $50 150 <br />2. State Surcharge, 4 Tanks x S56 224 <br />Total Number of Tanks 4 <br />Total Fee Due $524 <br />"Both closures will be conditioned. Contact a Health District Representative. <br />2-86 <br />