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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. BOX 2009 <br /> Stockton, Ca 95201 <br /> (2109) 466-6781 <br /> Jo9i Khanna , M.D. , Health Officer <br /> <br /> <br /> 5000 S. AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Billing statement for _ 1gA7 _`_ , Underground Tank Facility. <br /> Statement Date: OCTOBER 15, 1987 Due OCTOBER 31, 1987 <br /> Facility $ <br /> Container # *Status Container # *Status <br /> S ---- S <br /> State surcharges @ $56 per tank x 1 = $ 56.00 (Tank #1) <br /> Subtotal of permit fees : $ <br /> Additional Billings or credits _ $ <br /> TOTAL FEES DUE: $ 56.00 <br /> 'Penalties will be added Notify the San Joaquin local Health District <br /> Past due date as shown: of any correctionsor changes necessary. <br /> Permit will be mailed upon receipt of payment <br /> to days - loos of Base fee PAYMENT <br /> and approval of facility. <br /> RECEIVED <br /> Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Health District OCT 2 2 1987 <br /> • Environmental Health Permit/Services <br /> A active P. o. Bo. 2009. Stockton, CA 95201 ENVIRONMENTAL HEALTH <br /> IC - Temporary Closure PERMIT/SERVICES <br /> PC - Permanent Closure <br />