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ti <br /> I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Ave. , P. 0. Box 2009 ]/ddd�__ <br /> Stockton, CA 95201 <br /> (209) 466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> AMANA ENTERPRISES SAFEWI3 <br /> <br /> •1320 S. AURORA <br /> •STOCKTON, CA 95206 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: SEPTEMBER 3, 1987 <br /> Due: OCTOBER 3, 1987 <br /> Facility <br /> $ 100.00 <br /> Container # Status <br /> —I A 50.00 <br /> —2 A 50.00 <br /> —1 A 50.00 <br /> State surcharges @' $56 per tank x = <br /> Subtotal of permit fees: $ 250.00 <br /> Additional Billings or Credits <br /> Debit Balance Due 1986 (additional tanks <br /> & surcharge fees) $ 282.00 <br /> TOTAL FEES DUE: $ 532.00 <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: <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 />