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'1-E`l4bRK-SHEET PER EACH FACILITY <br /> • • <br /> DBA JEANNETTE MERTZ, FACILITY . <br /> ADDRESS 720 West Tokay Street, Lodi, California 95240 <br /> MA[LIt4G ADDRESS 720 West Tokay Street, Lodi, California 95240 <br /> 1• Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks # No $15-_0.00 <br /> ( Additional Tanks x $50) <br /> 2• State Surcharge (per tank ---- <br /> (Due with Permit Application. <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 1 Tanks) <br /> 3• *Temporary Closure 56.00 <br /> {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 /> (# No Temporary closures x $80) (See above #3 to calculate surchar e <br /> 4. "Permanent Closure (per tank) Undergroundg ) <br /> Storage Tank in which tI <br /> storage has ceased and where the owner/operator has no1PrA* s <br /> of re-using tank _ R F,C SID <br /> (# No Permanent Closures x $90) D C q 1� <br /> .5. Plan Check Fee $30. <br /> ENVIRO M LTA <br /> SERVICES <br /> P <br /> Total Number of Tanks One <br /> Total Fee Due $206.00 <br /> Make all fees payable to San Joaquin Local Health District. Enclose .this worksheet <br /> with your check <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> { 1 regular, 1 unleaded, 1 supreme, I waste oil ) <br /> la. Existing Facility & 1st Tank $150 <br /> h. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge, 4 Tanks x $56 22.4 <br /> Total Number of Tanks 4 Total Fee Due -- S5Z4`�' <br /> 'Cloth closures will be conditioned. Contact a Health District Representative. <br />