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FEE WORKSHEET EACH PER E CH F ACIL <br />16 IF- 21 ; <br />FACILITY <br />DBA W/N Food Store Inc. ADDRESS 7906 N El Dorado St., Stockton, CA 95207 <br />MAILING ADDRESS 2000 Alanneda De Las Pulgas, 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 />(# Permanent Closures x $90) <br />Total Number of Tanks 4 Total Fee Due <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) <br />la. Existing Facility & 1st Tank $150 <br />b. 3 Additional Tanks x $50 150 <br />2. State Surcharge, 4 Tanks x $56 224 <br />Total Number of Tanks 4 Total Fee Due $524 <br />. I <br />n ► a <br />*Both closures will be conditioned. Contact a Health District Representat WM Ei-IAL.HEALTH <br />F RiV IT/SERVEOE <br />2-86 0 40 <br />