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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.O. , Health Officer <br /> FIRES49 <br /> FIRESTONE TIRE & RUBBER COMPANY FIRESTONE TIRE & RUBBER COMPANY <br /> 4905 CLAREMONT <br /> <br /> <br /> <br /> Billing statement for I987 Permit , Underground Tank Facility. <br /> Statement Date: MAY 1 1987 <br /> Due: JUNE 1 , 1987 <br /> Facility S100.00 <br /> Container N `Status <br /> -L A 1--woo <br /> State surcharges @ $56 per tank x = �_— <br /> Subtotal of permit fees: <br /> S1i0 QO <br /> Additional Billings or Credits <br /> TOTAL FFfS DUE : 5150.00 <br /> Penalties will be added Notify the San Joaquin Local Health District j; <br /> past due date as shoran: 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 Has, Fee <br /> Return paynent along with one copy of this <br /> statement to : <br /> San Joaquin Local health District <br /> Environmental Health PermiL/Services <br /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> TL - Temporary Closurv• <br /> I'( - Perman,""I rin:ur,• <br />