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i�Ebl iTTAlicE 000 <br /> 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 /> CONTII7 <br /> • CONTINENTAL <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 / Status <br /> 1 A $ 50.00 <br /> 2 .A $ so.00 <br /> 3 $ 50.00 <br /> State surcharges @ $56 per tank x _ _ �— <br /> Subtotal of permit fees: $250.00 <br /> Additional Billings or Credits <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 - 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 />