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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 /> CHEVR10 <br /> CHEVRON USA, INC CHEVRON USA, ICNC. #90959 <br /> <br /> 103 WEST 11th STREET <br /> TRACY, CA 95376 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: MAY 1. 1987 <br /> Due: JUNE 1, 1987 <br /> Facility S 100.00 <br /> Container N Status <br /> —1_ A 50.00 <br /> _Z A 50.00 <br /> 1 _ A S 50.00 <br /> 4 A S 50.00 <br /> State surcharges @ $56 per tank x <br /> Subtotal of permit _fees: S snn_n0 <br /> Additional Billings or Credits <br /> TOTAL- FEES DUE: <br /> $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 !lase Fee Return payment along with one copy of this <br /> statement to: <br /> San Joaquin Local Health District <br /> Environmental Ilealth Permit/Services <br /> A - Active P. 0. Box 2009, Stockton. CA 95201 <br /> TC - Temporary Closure <br /> P( - Permanent. closur+. <br />