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pop <br /> FEE &O,SHEET PER EACH FACAP <br /> FAClL1TY Z <br /> DBA Gary L. Burgin ADDRESS '949e—E Hwy 120, Manteca, CA 95336 <br /> HAILING ADDRESS 2000 Alameda De Las Pulaas San Mateo CA 94403 <br /> 1. New Facility or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) <br /> 2. Operating Permit Application/Annual Inspection Fee <br /> a. Existing Facility and 1st Tank @ $150. 150 <br /> b. Additional Tanks (# 3 Additional Tanks x $50) 150 - <br /> 3. State Surcharge (per tank) (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total # 4 Tanks) 224 <br /> 4. *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) (See above #3 to calculate surcharge) <br /> 5. *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 /> (r Permanent Closures x. $90) <br /> Total Number of Tanks 4 Total Fee Due a G 4►.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, 1 waste oil ) ; r <br /> la. Existing Facility & lst Tank $1 , f <br /> b. 3 Additional Tanks x $50 if APIA 1 lYdb <br /> 2. State Surcharge, 4 Tanks x $56 224 <br /> 6'WROFOEfvTAL HEALTH <br /> Total Number of Tanks 4 Total Fee Due $524 FERfAIT/SERVICES <br /> *Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br />