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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> •TAKAHI3 <br /> 'Ron Takahashi •RON TAKAHASHI <br /> 1313 E. Charter •1313 E. CHARTER WAY <br /> Stockton, CA 95205 •STOCKTON, CA 95205 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: March 15, 1987 <br /> Due: April 15, 1987 <br /> Facility $ 100.00 <br /> Container N 'Status <br /> 1 50, <br /> 2 A Q PAYMENT <br /> 3 $ BO.0p RECEIVED <br /> APR 16 1987 <br /> ENVIRONMENTAL HEALTH <br /> State surcharges @ $56 per tank x = PERMIT/SERVICES <br /> Subtotal of permit fees: $ 250.00 <br /> Additional Billings or Credits <br /> $ <br /> TOTAL FEES DUE: $ 250.00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> past due date as shown: of any corrections or changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> and approval of facility. <br /> 30 days - 100% of Base Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Health District <br /> * Environmental Health Permit/Services <br /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> v w <br />