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� �S�i _.`, ._ " �."- x s�f,";'Srl �.k rr y, r .'`.. _ � ::� ,�,� .'�u"'",', �, 3 � � ��tilg„ � ask 9 p ,., -•n <br /> Ap <br /> FEE WORKSHEET PER EACH FACI L Ia. : ' <br /> FACILITY ' <br /> DBA ADDRESS 3303 E. Waterloo Road Stockton <br /> MAILING ADDRESS ter O <br /> M) � <br /> 1. . New Faci l i ty or Addition <br /> a. First Tank $180. <br /> b. Additional Tanks (# Additional Tanks x $50) fir * <br /> 8 f}Q <br /> 2. Operating Permit Application/Annual Inspection Feea <br /> j <br /> a. Existing Facility and 1st Tank @ $150. <br /> 2 ' ,� 100 . 00 q <br /> b. Additional Tanks (# Additional Tanks x $50} <br /> ' 3. State Surcharge (per tank) (Due with Permit Application, <br /> to <br /> Al- <br /> on renewal or amendment of operation permit and temporary closure) <br /> <($56 x Total # _ Tanks) <br /> 4 *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has has ceased but where the owner/operator, proposes to <br /> r re-use tank within 2 years. b ` <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 intents <br /> of re-�u-sing tank i.!;' r, ne-t 2 v,F.:ars �a s <br /> F <br /> (# Permanent Closures x $90) <br /> MR a 4 �s M S ✓ - x k' r„r i '�+ '' F'r L ro - `a � ' ,��.,a t ..im. '�a'�l,ce,y, <br /> .,3 <br /> Total Fee Due 41 <br /> 6 i , <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> �`. with your check. <br /> 3Sat <br /> a EXAMPLE - Annual Fee for Facility with 4 Tanks , : <br /> a <br /> z <br /> v . <br /> ' 3 . (1 regular, 1 unleaded, 1 supreme, 1 waste oil ) <br /> -1,la. Existing Facility & lst Tank $150 <br /> b, 3 Additional Tanks x $50F 150 � � <br /> si$ <br /> 2. State Surcharge, 4 Tanks x 56 z 224 � � � <br /> r , <br /> g <br /> Total Number of Tanks 4 Total NFee Due $524 <br /> n <br /> *Both closures will be conditioned. Contact a Health District Representative. 6° <br /> 2-86 <br /> t ji <br /> 4- <br /> _11i, <br />