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la. Existing Facility & 1st Tank < <br />b. 3 Additional Tanks x $50 15 <br />2. State Surcharge, 4 Tanks x $56 22 <br />APR 1 Wb <br />Total Number of Tanks 4 Total Fee Due $524 <br />ENVIROMf=NTAL i . � ALTK', ` <br />FERMIT/SERVKi O'ES <br />*Both closures will be conditioned. Contact a Health District Representative. <br />Alt <br />2-86 <br />F <br />Ss�- <br />14 <br />57 <br />0 <br />, <br />v0G`,;SHEET PER EACH FAC ILI <br />FACILITY <br />s' <br />DBA <br />A•; <br />Roley's Inc. ADDRESS 1612 Hammer Lane, Stockton, CA 95207 ;r <br />MAILING <br />ADDRESS 2000 Alameda De Las Pulgas, San Mateo, CA 94403 <br />1. <br />New Facility or Addition <br />4 <br />a-. first Tank $180.f <br />za <br />b. Additional Tanks (#_ Additional Tanks x $50)� <br />2. <br />Operating.Permit Application/Annual Inspection Fee <br />" <br />a. Existing Facility and 1st Tank @ $150, <br />150 �§ <br />b. Additional Tanks (# 4 Additional Tanks x $50) <br />200 <br />3. <br />State Surcharge (per tank) (Due with Permit Application, <br />on renewal or amendment of operation permit and temporary closure) <br />($56 x Total # 5 Tanks) <br />280` <br />4. <br />*Temporary Closure (per tank) Underground Storage Tank in which <br />storage has ceased but where the owner/operator proposes to <br />t iFt�� <br />re -use tank within 2 years. <br />` <br />(# Temporary closures x $80) (See above #3 to calculate surcharge) <br />f <br />T <br />5. <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 />(# Permanent Closures x $90) <br />Total Number ref Tanks Total Fee Due <br />{F <br />Pei <br />A <br />I <br />. <br />Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br />withy our check. <br />d <br />EXAMPLE - Annual Fee for Facility with 4 Tanks <br />k <br />(1 regular, 1 unleaded, 1 supreme, 1 waste oil) <br />r <br />$150 <br />la. Existing Facility & 1st Tank < <br />b. 3 Additional Tanks x $50 15 <br />2. State Surcharge, 4 Tanks x $56 22 <br />APR 1 Wb <br />Total Number of Tanks 4 Total Fee Due $524 <br />ENVIROMf=NTAL i . � ALTK', ` <br />FERMIT/SERVKi O'ES <br />*Both closures will be conditioned. Contact a Health District Representative. <br />Alt <br />2-86 <br />F <br />Ss�- <br />