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s.• v <br /> 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 /> •ALLEN29 <br /> A. A. 4 BOB ALLEN, INC. 'A. A. & BOB ALLEN, INC. <br /> 2904 BEYER LANE '2904 BEYER LANE <br /> STOCKTON, CA 95205 -STOCKTON, CA 95205 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: APRIL 1, 1987 <br /> Due: MAY 1, 1987 <br /> Facility b 100.00 <br /> Container N Status <br /> —L A 50.00 <br /> PAYMENT <br /> �— RECEIVED <br /> MAY i3 1yo <br /> State surcharges @ $56 per tank x _ ENVIRONMENTAL HEALT\ <br /> PERMIT/SERVICE$ <br /> Subtotal of permit—fees: b150.00 GV7Q,(�D <br /> Additional Billings or Credits f ` , 0 <br /> b _I <br /> TOTAL FEES DUE: _ b 150.00 <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 />