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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 /> 00 <br /> 150, <br /> b. Additional Tanks (# 3 Additional Tanks x $50) <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) <br /> ,.r✓V f <br /> TL <br /> L II R Ta I I h J <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 Total Fee Due <br /> 4 <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 /> (l regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank -'aINA <br /> b. 3 Additional Tanks x $50 (9 1 Z <br /> 2. State Surcharge, 4 Tanks x $56 JOIN 29 '19W <br /> Total Number of Tanks 4 TotLWA&0MWTAL$MfALT14 <br /> PERMIT/SERVICES <br /> �ow <br /> *Both closures will be conditioned. Contact a Health District Representa ive�A N 2 <br /> ENVIRCs?,;Ei�rAL HEAjH <br /> 12/85 F'ERTAIT/SERVICES <br />