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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 /> . CALIF31 <br /> CALIFORNIA TANK <br /> <br /> _ STOCKTON, CA 95206 <br /> Billing statement for 1987 Permit _, Underground Tank Facility. <br /> Statement Date: MAY 1, 1987 <br /> Due: JUNE 1, 1987 <br /> Facility $ 100.00 <br /> Container A *Status <br /> 1 A $ 50.00 <br /> .2 A $ 50.00 <br /> _ 3_ A — 5 0- GO <br /> 4 A 0 <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit fees: $ 300-o <br /> Additional Billings or Credits <br /> TOTAL FEES DUE: $ 300.00 <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 /> and approval of facility. <br /> 30 days - 100% of Base Fee 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. Bax 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />