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r <br /> FEE WORKSHEET <br /> DBA LODI IRON WORKS, INC. <br /> ADDRESS S20 S. Sacramento Street (P.O. BOX 1150) Lodi , Calif. 95240 <br /> 1. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150. <br /> b. Additional Tanks (# 2 Additional Tanks x $50) 100. <br /> 2. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit) 168 <br /> ($56 x Total # 3 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) -0- <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) '0' <br /> Total Number of Tanks _3_ Total Fee Due 418.00 <br /> Q�" <br /> Make all fees payable to San Joaquin Local Health District. Enclose this works <br /> with your check and the completed application. <br /> b <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> la. Existing Facility & 1st Tank `- <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 V <br /> --FEB 2 5 198b <br /> Total Number of Tanks 4 Total Fee Due WIROMENTAL HEALTH <br /> FERMIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 12/85 <br />