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! SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> et1601 E. Hazelton Ave. , P. 0. Box 2009 <br /> Stockton; CA 95201 <br /> (209) -466-6781 <br /> Jogi Khanna, M.D. , health Officer <br /> .ERCARI7 <br /> ,E. R. CARPENTER CO. , INC. <br /> E. R. Carpenter ,17100 S.HARLAN RD. <br /> P. 0. BOX 279 .LATHROP, CA 95330 <br /> LATHROP, CA 95330 <br /> Billing statement for 1987 Permit Underground Tank Facility. <br /> Statement Date: APRIL 1, 1987 <br /> Due: MAY 1, 1987 <br /> Facility 100 <br /> Container # *Status <br /> 1 A $ 50 <br /> State surcharges @'$56 per tank x <br /> .Subtotal of permit- fees: - $r_sn_no- <br /> Additional <br /> r Additional Billings or Credits <br /> $ <br /> TOTAL FEES DUE: $ 150.00 <br /> Penalties will be added Notify the San Joaquin Local Health District <br /> after- 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. Box 2009, Stockton, CA 95201 <br /> TC - Temporary Closure <br /> PC - Permanent Closure <br />