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/a2a2 oiy� <br /> 00477093 <br /> ' v <br /> v- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E. Hazelton Avenue, P 0 Box 2009 SFC HDL „S „ <br /> Stockton, CA 95201 <br /> (209)466-6781 <br /> Jogi Khanna, Y.D. , Health Officer <br /> DIAMOND WALNUT •DIAMOI0 <br /> P. 0. BOX 1727 DIAMOND IIALNUT <br /> STOCKTON, CA 95201 1020 DIAMOND <br /> STOCKTON, CA 95205 <br /> Billing statement for 1987 Underground Tank Facility . <br /> Statement Date: OCTOBER 20, 1987 Date Due OCTOBER 31._..1987 <br /> 1986 1987 <br /> Facility Facility $100.00 <br /> Tank If *Status Tank # *Status <br /> --- —1�_ S 50— 8 -A— f 550 IWO#} <br /> 0 d_7/87 PC _ �— NOV O 1 1987 <br /> —S _ — A.rCOUNTS PAY-QLE <br /> PAYMENT <br /> RECEIVED <br /> State surcharges A $56 per tank x 4 = $ 224.00 N 41987 <br /> Subtotal of permit fees 1986 $ 200.00(4 additional tanks <br /> )'�� <br /> Subtotal of permit fees 1987 $ 540.00 ENVIRONMENTAL HEALTH <br /> TOTAL FEES DUE: $ 964.017ERMfTjSERVtCES <br /> *A - Active RECEIVED <br /> TC - Temporary Closure OCT 3 1981 <br /> PC - Permanent Closure <br /> A/P DEPT. <br /> Notify the San Joaquin Local Health 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 /> P O Box 2009 , Stockton , CA 95201 <br /> RF•G�►y �� <br /> PENALTIES WILL BE ADDED <br /> PAST DUE DATE AS SHOWN: QCT " X987 <br /> 30 DAYS- 100% of BASE FEE / _ 6 Mf Abp pEPT <br /> r <br />