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FEE WORKSHEET <br /> DBA DELTA BLOOD BANK <br /> ADDRESS 65 No. Commerce Mail: P.O. Box 230 Stockton CA 95201-9973 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> (c1-6 x Total # I Tanks) <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) $90 nn <br /> Total Number of Tanks Total Fee Due 90.00 <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> II <br /> with your check and the completed application. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks V <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 2241 a <br /> Total Number of Tanks 4 Total Fee Due $5��+(=r6avT0 <br /> 24 <br /> FE8 3 lydo <br /> *Both closures will be conditioned. Contact a Health District RepresI NTAL HEALTH <br /> PERMIT/SERVICES <br /> 12/85 <br />