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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P O Box 2009 <br /> Stockton , CA 95201 <br /> (209)466-6781 <br /> Jogi Khanna, M.D. , Health Officer <br /> . CAPITAL VENTURE ENTERPRISES BEAUL40 <br /> . <br /> 400 S. AURORA <br /> STOCKTON, CA <br /> Billing statement for 1986 - 1987 Underground Tank Facility . <br /> Statement Date: JUNE 24, 1987 Date Due JULY 15, 1987 <br /> 1986 1987 <br /> Facility X100.00 Facility _$100.00 <br /> Tank # *Status Tank # *Status <br /> 1 A S 50.00 1 A S 50.00 <br /> 2 —� ADO --2— -W- -5U.UO PAYMENT <br /> RECEIVED <br /> AUG 2G 1987 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> State surcharges 0 $56 per tank x 2 - $_112.00 <br /> Subtotal of permit fees 1986 $ 200.00 <br /> Subtotal of permit fees 1987 $ 200.00 <br /> TOTAL FEES DUE: $ 512.00 <br /> 'A - Active <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br /> Notify the San Joaquin Local Ilealth District of any corrections or changes <br /> necessary . <br /> Return payment along with one copy of this statement to: <br /> San Joaquin Local Health District <br /> Environemntal Health Permit/Services <br /> 1' 0 Dox 2009, Stockton , CA 95201 <br />