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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 /> • CONTI17 <br /> • <br /> <br /> . MANTECA, CA 95336 <br /> Billing statement for 1987 PERMIT Underground Tank Facility. <br /> Statement Date: APRIL 15, 1987 <br /> Due: MAY 15, 1987 <br /> Facility $ 100.00 <br /> Container 9 *Status <br /> 1 A $ 50.00 <br /> 2 g $ SO-00 <br /> 3 $ 50.00 <br /> PAYMENT <br /> RECEIVED <br /> State surcharges @ $56 per tank x _ _ $__ MAY 4 1y8 ( <br /> Subtotal of permit fees: $250.00 <br /> tNVIRONMENTAL HEALTH <br /> Additional Billings or Credits PERMIT/SERVICES <br /> (Credit Balance Forward) <br /> - $ 30.00 <br /> TOTAL FEES DUE: $ 220.00 <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 - 100X of Base Fee Return payment along with one copy of this <br /> 'statement to: <br /> San Joaquin Local Health District <br /> t Environmental Health Permit/Services <br /> A - Active P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />