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.. ,i <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 /> .WILLIAM L. SHAWVER - SHAWV91 <br /> <br /> • 916 N. BROADWAY <br /> • 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 $ 100.00 <br /> Container N Status <br /> 1 A g 50.00 <br /> — $ PAYMENT <br /> RECEIVED <br /> State surcharges @ $56 per tank x _ _ APR 16 1yb/ <br /> Subtotal of permit fees: E 150.00 ENVIRONMENTAL HEALTH <br /> Additional Billings or Credits PERMIT/SERVICES <br /> 5 <br /> TOTAL FEES DUE: $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 i <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />