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,1A7TACK TO ONCK - <br /> FEE-WORKSHEET <br /> DBA H. J. Heinz Company <br /> P. 0. Box 57 757 E. 11th St. <br /> ADDRESS Tracy, CA 95378-0057 Tracy, CA 95376 <br /> I. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 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 /> "c <br /> ,, , <br /> M", Total # 1 Tanks) _ _ 56 <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 one dotal Fee Due $206 <br /> Make all ,fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> with your check and the completed application. <br /> EXAMPLE Annual Fee for- Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tankb � rt��� - <br /> b. 3 Additional Tanks x $50 a v O <br /> 2. State Surcharge, 4 Tanks x $56 4 FEB 18 lytSb <br /> Total Number of Tanks 4 Toial Fee Due "MRUMENTAL HEALTH <br /> FERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />