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SAN JOAQUIN LOCAL HEALTH DISTRICT <br />1601 E. Hazelton Ave., P. 0. Box 2009 <br />1 <br />Stockto CA 95201 <br />(209) 466-6781 <br />Jogi Khanna, M.D., Health Officer <br />N U 5 1981 - <br />J <br />ENVIRORAENTAL HEALTH <br />FERMIT/SERVICES <br />. EDISO14 <br />.STOCKTON UNIFIED SCHOOL DISTRICT . STOCKTON UNIFIED SCHOOL DISTRICT <br />"? <br /> 1425 S. CENTER SIKEEI <br />STOCKTON, CA <br />Billing statement for 1987 Permit Underground Tank Facility. <br />Statement Date: l AY 1. 1987 <br />Due: QUNE 1, 1987 <br />Facility $ 100.00 <br />Container N 'Status <br />—1_ A $ 50.00 <br />_.2. A t .n.Oc <br />State Surcharges @ $56 per tank x _ _ $— <br />Subtotal of permit fees: <br />Additional Billings or Credits <br />Per�1t+:es will be added <br />past due date as shown: <br />30.days - 100% of Base Fee <br />4 <br />A - Active <br />TC - Temporary Closure <br />PC - Permanent Closure <br />$ 200.00 P <br />S - \0" rk, <br />TOTAL FEES DUE: S2no-oo <br />Uoti`, the an Joaquin Local Health District <br />of any corrections or changes necessary. <br />Permit will be mailed upon receipt of payment; <br />and approval of facility. <br />Return payment along with one copy of this <br />statement to: <br />San Joaquin Local Health' District <br />Environmental Health Permit/Services <br />P. 0. Box 2009, Stockton., CA 95201 <br />