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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 /> STATE MILITARY DEPARTMENT ' STOCC80 <br /> <br /> 8010-8020 S. AIRPORT WAY <br /> STOCKTON, CA 95206 <br /> Billing statement for 1987— Permit Underground Tank Facility. <br /> Statement Date: JUNE 1, 1987 <br /> Due: 1111 Y t 1987 <br /> Facility $ 100.00 <br /> Container # 'Status <br /> 2 PC 90.00 <br /> 3 <br /> 4 PC 90.00 <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $ 380.00 <br /> Additional Billings or Credits <br /> Debit Balance Forward 1986 <br /> (additional tank & surc arge) $ 106.00 <br /> TOTAL FEES DUE: $486.00 <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 /> 30 days - 100% of Base Fee and approval of facility. <br /> Return payment along with one copy of this <br /> statement to: Y tA ENT <br /> San Joaquin Local Health District Rg GEN E t) <br /> Environmental Health Permit/Services7 <br /> A - Active P. 0. Box 2009, Stockton, CA 95201 JAN 2 4 �';01 <br /> TC - Temporary Closure ENTAL FIEALTH <br /> PC - Permanent Closure ENVIRONM SERVICES <br /> PERMIT i <br />