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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton, CA 95201 <br /> (209) 466-6181 <br /> Jogi Khanna, M.D. , Health Officer <br /> 'PHILLIO <br /> ROBERT PHILLIPS TRUCKING -ROBERT PHILLIPS TRUCKING <br /> 10564 E. ADA AVE. •10564 E. ADA AVE. <br /> STOCKTON, CA 95205 •STOCKTON, CA 95205 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: JUNE 1, 1987 <br /> Due: JULY 1, 1987 gA <br /> Facility $ 100.00 <br /> Container N Status <br /> 1 50.00 <br /> A 50.0 <br /> � i <br /> State surcharges @ $56 per tank x`= $ <br /> Subtotal of permit fees: $200.00 <br /> Additional Billings or Credits —T (Z' <br /> 9API fin <br /> TOTAL FEES DUE: <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 <br /> P. 0. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />