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J <br /> 1 <br /> FEE WORKSHEET <br /> DBA ENERGY PETROLEUM INC. <br /> ADDRESS PORT ROAD 21 & M, P. O.BOX 744, STOCKTON, CALIF. 95201 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150.00 <br /> b. Additional Tanks (# 3 Additional Tanks x $50) 150.00 <br /> 2, State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> T an' <br /> . '2�I 00 <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 /> 0" <br /> Total Number of Tanks Total Fee Due <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 /> itIa. Existing Facility & 1st TankLF+ <br /> b. 3 $ <br /> x Tanks Additional n 1 50 1 <br /> . <br /> 2. State Surcharge, 4 Tanks x $56 J A N Z 9 <br /> Total Number of Tanks 4 Tot KIVYIWjh[Fj4TAL$PJEALTH _ <br /> FERMIT/SERVICES <br /> rr <br /> IV, � <br /> *Both closures will be conditioned. Contact a Health District Re resenta ivev A N 22 is � <br /> 12/85 F-WRomENTAL HEALTH <br /> FF-VIT/SEiRVICES <br />