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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95101 <br /> (209) 466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> ELLIS82 <br /> - LANCE ELLIS ELLIS CAR WASH <br /> <br /> LODI , CA 95240 <br /> Billing statement for 1981 Permit Underground Tank Facility. <br /> Statement Date: MAY 1, 1987 <br /> Due: JUNE 1, 1987 <br /> Facility S 100.00 <br /> Container N Status <br /> 1 A5S J <br /> 2 _T <br /> 3 —A' <br /> 4 5�0 PAYMENT <br /> RECEIVED <br /> �— MAY 1319d / <br /> State surcharges @ $56 per tank x _ = �_ ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> Subtotal of permit fees: $ 300 <br /> Additional Billings or Credits <br /> TOTAL FEES DUE : S 310 .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 /> 30 days - 100% of Base Fee 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 /> A - Active P. 0• Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />